Evaluating Total Parenteral Nutrition after Pylorus-preserving Pancreatoduodenectomy (PPPD)

Park, Yun Hee; Kim, Sung Eun; Kim, Jae Youn; Song, Young Cheon; Hong, Suk Kyung

Abstract

PURPOSE
Pylorus-preserving pancreatoduodenectomy (PPPD) is considered the treatment of choice for various periampullary diseases. Although patients who undergo PPPD require postoperative parental nutrition, no guideline has currently been established for this specific group. The aim of this study is to evaluate the TPN given to patients after PPPD and to identify a standard protocol for these patients.
METHODS
We conducted a retrospective study that reviewed the patients in Asan Medical Center who had undergone PPPD and who had received TPN from January to December in 2007. TPN utilization was evaluated with assessing the supplemented calories and the duration of the TPN. The observed outcomes were the changes in the nutritional status of each patient, the morbidity, the mortality and the length of the hospital stay.
RESULTS
A total of 160 patients were enrolled in this study and of these, 118 patients were malnourished. The worse the preoperative nutritional status was for each patient, the longer the TPN was required and this was also true for the length of the hospital stay. The mean calories and protein values given through TPN were 35.15 kcal/kg and 1.39 g/kg, respectively. This was more excessive than the recommended levels (33.02 kcal/kg and 1.34 g/kg, respectively) when considering each patient's nutritional status. We classified the patients by the ratio of supplied calories to the recommended calories; the low-calories group (<90%; n=26), the adequate calories group (90~110%; n=74) and high-calories (>110%; n=60) group. The duration of TPN (9.5d, 10.3d and 12.6d) and the length of the postoperative hospital stay (22.0d, 23.3d and 26.4d) were not statistically different between the groups. The rate of metabolic abnormalities and infectious complications were higher in the over-calories group (71.7% and 25%, respectively) when compared to that of the other two groups (67% and 14%, respectively). Major complications such as delayed gastric emptying, fistulae and anastomotic leakage were not significantly different between the groups.
CONCLUSION
In this study, excessive calorie supplementation had no significant benefit on the outcome of patients after PPPD. Therefore, we suggest that an adequate amount of nutrition, with giving consideration for the pre-existing nutritional status, will be advantageous for the cost-benefit aspect.