Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.115621
Revised: December 25, 2025
Accepted: January 22, 2026
Published online: March 27, 2026
Processing time: 126 Days and 3.5 Hours
Pancreaticoduodenectomy (PD) is a key surgical procedure for treating pancreatic head and periampullary tumors. Postoperative anastomotic leakage (AL) is a common, yet serious, complication. However, the relationship between the timing of early enteral nutrition (EEN) and the risk for AL remains controversial, which prompted this single-center retrospective cohort study including data from patients who underwent PD at the authors’ institution between January 2023 and December 2024.
To investigate the correlation between the timing of initiating EEN and the in
Patients who underwent PD were divided into 2 groups (n = 100 each) based on initiation of postoperative EEN: Study (≤ 24 hours); and control (> 72 hours). The incidence of total postoperative AL, pancreatic, biliary, and gastrointestinal fistulas, serum albumin (ALB), prealbumin (pre-ALB), and transferrin (TF), time to recovery of bowel sounds, first flatus and defecation, and length of post
Serum ALB, pre-ALB, and TF levels in the study group were significantly higher, and times to recovery of bowel sounds, first flatus and defecation, and length of postoperative hospital stay were significantly shorter in the study group than those in the control group (P < 0.05). Furthermore, the total incidence of AL and grade B/C pancreatic fistulas were significantly lower (P < 0.05), with no statistical difference in the incidence of biliary and gastrointestinal fistulas between the 2 groups (P > 0.05). Multivariate logistic regression analysis revealed that initiating EEN ≤ 24 hours after surgery was an independent protective factor against AL, whereas soft pancreatic texture, pancreatic duct diameter < 3 mm, and prolonged operative duration were independent risk factors.
Initiating EEN ≤ 24 hours after PD reduces the incidence of total AL and pancreatic fistulas, effectively improving postoperative nutritional status, accelerating recovery of gastrointestinal function, and shortening hospital stay.
Core Tip: This retrospective cohort study, involving data from 200 patients who underwent pancreaticoduodenectomy, revealed that initiating early enteral nutrition (EEN) ≤ 24 hours versus > 72 hours postoperatively, was an independent protective factor against total anastomotic leakage and clinically relevant (grade B/C) pancreatic fistulas. EEN was also associated with significantly improved nutritional status (serum albumin, prealbumin, and transferrin levels), accelerated recovery of gastrointestinal function, and shortened hospital stay. These findings challenge traditional delayed feeding practices and support the integration of EEN into enhanced recovery pathways for this major surgery.