Korean J Hepatobiliary Pancreat Surg.  2014 Aug;18(3):84-89. 10.14701/kjhbps.2014.18.3.84.

Clinical feasibility and nutritional effects of early oral feeding after pancreaticoduodenectomy

• Hwang SE
• Jung MJ
• Cho BH
• Yu HC

• KMID: 1802219
• DOI: http://doi.org/10.14701/kjhbps.2014.18.3.84

Abstract

BACKGROUNDS/AIMS
Pancreaticoduodenctomy (PD) is associated with high rates of postoperative morbidity and mortality. Although many studies have shown that early postoperative enteral nutrition improves postoperative outcomes, limited clinical information is available on postoperative early oral feeding (EOF) after PD. The aim of this study was to evaluate the clinical feasibility, safety, and nutritional effects of EOF after PD.
METHODS
Clinical outcomes were investigated in 131 patients who underwent PD between 2003 and 2013, including 81 whose oral feeding was commenced within 48 hours (EOF group) and 50 whose oral feeding was commenced after resumption of bowel movements (traditional oral feeding [TOF] group). Postoperative complications, energy intake, and length of stay (LOS) were reviewed.
RESULTS
Demographic factors were similar in the two groups. The EOF group had a significantly shorter LOS (25.9+/-8.5 days vs. 32.3+/-16.3 days; p=0.01) than the TOF group. The rates of anastomotic leak (1.2% vs. 16%, p=0.00) and reoperation (3.7% vs. 20%, p=0.01) were significantly lower in the EOF group. In the clinically acute phase from postoperative day 1 to day 5, the mean daily calorie intake (847.0 kcal vs. 745.6 kcal; p=0.04) and mean daily protein intake (42.2 g vs. 31.9 g; p=0.00) in the EOF group were significantly higher than that in the TOF group.
CONCLUSIONS
Postoperative EOF is a clinically safe, feasible, and effective method of nutritional support after PD.

Keyword

Early oral feeding; Pancreaticoduodenectomy; Length of stay; Complication

MeSH Terms

Anastomotic Leak
Demography
Energy Intake
Enteral Nutrition
Humans
Length of Stay
Mortality
Nutritional Support
Pancreaticoduodenectomy*
Postoperative Complications
Reoperation

Figure

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  Fig. 1 Mean daily total calorie and protein intake in the EOF and TOF groups. Patients in the EOF and TOF groups received 30% and 17%, respectively, of their calorie goals through the enteral route and 41% and 51%, respectively, through the parenteral route from POD 1 to 14. Patients in the EOF and TOF groups received 23% and 14%, respectively, of their protein goals through the enteral route and 41% and 52%, respectively, through the parenteral route. The mean daily calorie (1018 kcal vs. 972 kcal; p=0.30) and protein (44.3 g vs. 44.4 g; p=0.98) intake from POD 1 to 14 were similar in the EOF and TOF groups. From POD 1 to 5, however, the mean daily calorie (847.0 kcal vs. 745.6 kcal; p=0.04) and protein (42.2 g vs. 31.9 g; p=0.00) intake was significantly higher in the EOF than in the TOF group, as was the mean percentage of total daily calorie (60.1% vs. 51.3%; p=0.02) and protein (62.1% vs. 45.9%; p=0.00) intake. Arrows indicate a percent of requirement of energy and protein from postoperative day 1 to 5. EOF: early oral feeding; TOF: traditional oral feeding; POD: postoperative day.

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