Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity

Gerritsen, Arja; Wennink, Roos A.W.; Besselink, Marc G.; Santvoort, Hjalmar C. van; Tseng, Dorine S.J.; Steenhagen, Elles; Rinkes, Inne H.M. Borel; Molenaar, I.

doi:10.1111/hpb.12197

Cited by 53 publications

(40 citation statements)

References 29 publications

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“…A total of 51 articles were utilized for the review, with 14 addressing malnutrition and pancreatic dysfunction at pancreatic cancer diagnosis [13,14,15,16,17,18,19,20,21,22,23,24,25,26]; 19 addressing pancreatic dysfunction after surgery [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], including 10 which also discussed preoperative dysfunction and nutrition [27,30,31,32,33,35,37,39,40,41]; and 18 addressing nutritional intervention [11,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62] (Figure 1). …”

Section: Resultsmentioning

confidence: 99%

“…Results showed that NJEEN was associated with a significantly higher frequency and severity of postoperative pancreatic fistula (POPF), but did not result in a significant difference in the incidence of postoperative hemorrhage, infection, grade of complications, and length of stay. In contrast, Gerritsen et al found that early oral feeding after PD resulted in a decreased length of hospital stay and no differences in Clavien-Dindo Grade III or higher complications, delayed gastric emptying, postoperative hemorrhage, and mortality when compared to patients who received nasojejunal tube (NJT) feeding [49]. As such, introducing oral feeding earlier than previously estimated may reduce the hospitalization time with minimal secondary drawbacks in patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

et al. 2017

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Pancreatic cancer is an aggressive malignancy with a poor prognosis. The disease and its treatment can cause significant nutritional impairments that often adversely impact patient quality of life (QOL). The pancreas has both exocrine and endocrine functions and, in the setting of cancer, both systems may be affected. Pancreatic exocrine insufficiency (PEI) manifests as weight loss and steatorrhea, while endocrine insufficiency may result in diabetes mellitus. Surgical resection, a central component of pancreatic cancer treatment, may induce or exacerbate these dysfunctions. Nutritional and metabolic dysfunctions in patients with pancreatic cancer lack characterization, and few guidelines exist for nutritional support in patients after surgical resection. We reviewed publications from the past two decades (1995–2016) addressing the nutritional and metabolic status of patients with pancreatic cancer, grouping them into status at the time of diagnosis, status at the time of resection, and status of nutritional support throughout the diagnosis and treatment of pancreatic cancer. Here, we summarize the results of these investigations and evaluate the effectiveness of various types of nutritional support in patients after pancreatectomy for pancreatic adenocarcinoma (PDAC). We outline the following conservative perioperative strategies to optimize patient outcomes and guide the care of these patients: (1) patients with albumin < 2.5 mg/dL or weight loss > 10% should postpone surgery and begin aggressive nutrition supplementation; (2) patients with albumin < 3 mg/dL or weight loss between 5% and 10% should have nutrition supplementation prior to surgery; (3) enteral nutrition (EN) should be preferred as a nutritional intervention over total parenteral nutrition (TPN) postoperatively; and, (4) a multidisciplinary approach should be used to allow for early detection of symptoms of endocrine and exocrine pancreatic insufficiency alongside implementation of appropriate treatment to improve the patient’s quality of life.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

et al. 2017

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“…In this study, dislodgement occurred in 36% of patients, which is comparable with previous studies in patients after pancreatoduodenectomy receiving tube feeding via an endoscopically placed tube. 3,4,9 A potential benefit of the EM-guided technique is that incorrectly placed or dislodged tubes, which are not completely removed, can be repositioned with the EM-guided stylet. This prevents discomfort because the tube does not have to pass the nose and oropharynx again and is less costly because the original tube and stylet can be used.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 These patients will have to undergo postoperative placement of a nasojejunal feeding tube, and up to 27% of these patients will require a second or third procedure because of dislodgement or blockage of the tube. 3,4,9 There are various techniques for nasojejunal feeding tube placement, but they all have their specific disadvantages. Blind placement of feeding tubes beyond the pylorus is frequently unsuccessful and may lead to complications such as pneumothorax and pneumonia due to inadvertent placement in the bronchus.…”

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confidence: 99%

Electromagnetic-Guided Versus Endoscopic Placement of Nasojejunal Feeding Tubes After Pancreatoduodenectomy

et al. 2016

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“…An observational study reported the effects of implementation of early oral feeding as compared to routine enteral feeding through a nasojejunal tube (NJT) [65]. The study found no significant difference in the incidence of POPF between the two types of feeding strategies (12 % vs. 12 %, p=0.999).…”

Section: Postoperative Approaches To Reduce the Rate Of Popfmentioning

confidence: 99%

Pancreatic Fistula and Delayed Gastric Emptying After Pancreatectomy: Where do We Stand?

et al. 2015

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Pancreatic resection has become a feasible treatment of pancreatic neoplasms, and with improvements in surgical techniques and perioperative management, mortality associated with pancreatic surgery has decreased considerably. Despite this improvement, a high rate of complications is still associated with these procedures. Among these complications, delayed gastric emptying (DGE) and postoperative pancreatic fistula (POPF) have a substantial impact on patient outcomes and burden our healthcare system. Technical modifications and postoperative approaches have been proposed to reduce rates of both POPF and DGE in patients undergoing pancreatectomy; however, to date, their rates have remained unchanged. In the present study, we summarize the findings of the most significant studies that have investigated these complications. In particular, several studies focused on technical modifications including extent of dissection, stent placement, nature of anastomosis, type of reconstruction, and application of biological or non-biological agents to site of anastomosis. Moreover, postoperatively, drain placement, duration of drain usage, postoperative feeding, and use of pharmacological agents were studied to reduce rates of POPF and DGE. In this review, we summarize the most relevant literature on this fundamental aspect of pancreatic surgery. Despite studies identifying the potential benefit of technical modifications and postoperative approaches, these findings remain controversial and suggest need for further extensive investigation. Most importantly, we recommend that all surgeons performing these procedures base their practice on the most updated and highest available level of evidence.

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Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity

Abstract: The introduction of an early oral feeding strategy after PD reduced the time to resumption of adequate oral intake and length of hospital stay without negatively impacting postoperative morbidity.

Cited by 53 publications

References 29 publications

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

Electromagnetic-Guided Versus Endoscopic Placement of Nasojejunal Feeding Tubes After Pancreatoduodenectomy

Pancreatic Fistula and Delayed Gastric Emptying After Pancreatectomy: Where do We Stand?

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