Ann Hepatobiliary Pancreat Surg.  2024 Feb;28(1):70-79. 10.14701/ahbps.23-071.

Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study

• Russell TB
• Labib PL
• Murphy P
• Ausania F
• Pando E
• Roberts KJ
• Kausar A
• Mavroeidis VK
• Marangoni G
• Thomasset SC
• Frampton AE
• Lykoudis P
• Maglione M
• Alhaboob N
• Bari H
• Smith AM
• Spalding D
• Srinivasan P
• Davidson BR
• Bhogal RH
• Croagh D
• Dominguez I
• Thakkar R
• Gomez D
• Silva MA
• Lapolla P
• Mingoli A
• Porcu A
• Shah NS
• Hamady ZZR
• Al-Sarrieh B
• Serrablo A
• RAW Study Collaborators
• Aroori S

• KMID: 2553368
• DOI: http://doi.org/10.14701/ahbps.23-071

Abstract

Backgrounds/Aims
After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes.
Methods
Data were extracted from the Recurrence After Whipple’s study, a retrospective multicenter study of PD outcomes.
Results
In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was “enteral only,” “parenteral only,” and “enteral and parenteral” in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m² (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN.
Conclusions
A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.

Keyword

Pancreaticoduodenectomy; Pancreatic ductal carcinoma; Nutritional status; Nutritional support; Nutritionists

Figure

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  Fig. 1 Cohort flow diagram. PD, pancreatoduodenectomy; PDAC, pancreatic ductal adenocarcinoma; AA, ampullary carcinoma; CC, cholangiocarcinoma.

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