Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study

  • Thomas B. Russell (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Peter L. Labib (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Paula Murphy (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Fabio Ausania (Department of HPB Surgery, Hospital Clinic de Barcelona) ;
  • Elizabeth Pando (Department of HPB Surgery, Hospital Universitari Vall d'Hebron) ;
  • Keith J. Roberts (Department of HPB Surgery, University Hospitals Birmingham NHS Foundation Trust) ;
  • Ambareen Kausar (Department of HPB Surgery, East Lancashire Hospitals NHS Trust) ;
  • Vasileios K. Mavroeidis (Department of HPB Surgery, University Hospitals Bristol NHS Foundation Trust) ;
  • Gabriele Marangoni (Department of HPB Surgery, University Hospital Coventry & Warwickshire) ;
  • Sarah C. Thomasset (Department of HPB Surgery, NHS Lothian) ;
  • Adam E. Frampton (Department of HPB Surgery, Royal Surrey NHS Foundation Trust) ;
  • Pavlos Lykoudis (Department of HPB Surgery, Hull University Teaching Hospitals NHS Trust) ;
  • Manuel Maglione (Department of HPB Surgery, Medical University of Innsbruck) ;
  • Nassir Alhaboob (Department of HPB Surgery, Ibn Sina Specialized Hospital) ;
  • Hassaan Bari (Department of HPB Surgery, Shaukat Khanum Memorial Cancer Hospital) ;
  • Andrew M. Smith (Department of HPB Surgery, Leeds Teaching Hospitals NHS Trust) ;
  • Duncan Spalding (Department of HPB Surgery, Imperial College Healthcare NHS Trust) ;
  • Parthi Srinivasan (Department of HPB Surgery, King's College Hospital NHS Foundation Trust) ;
  • Brian R. Davidson (Department of HPB Surgery, Royal Free London NHS Foundation Trust) ;
  • Ricky H. Bhogal (Department of HPB Surgery, The Royal Marsden NHS Foundation Trust) ;
  • Daniel Croagh (Department of HPB Surgery, Monash Medical Centre) ;
  • Ismael Dominguez (Department of HPB Surgery, Salvador Zubiran National Institute of Health Sciences and Nutrition) ;
  • Rohan Thakkar (Department of HPB Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust) ;
  • Dhanny Gomez (Department of HPB Surgery, Nottingham University Hospitals NHS Trust) ;
  • Michael A. Silva (Department of HPB Surgery, Oxford University Hospitals NHS Foundation Trust) ;
  • Pierfrancesco Lapolla (Department of HPB Surgery, Policlinico Umberto I University Hospital Sapienza) ;
  • Andrea Mingoli (Department of HPB Surgery, Policlinico Umberto I University Hospital Sapienza) ;
  • Alberto Porcu (Department of HPB Surgery, Azienda Ospedaliero Universitaria di Sassari) ;
  • Nehal S. Shah (Department of HPB Surgery, Sheffield Teaching Hospitals NHS Foundation Trust) ;
  • Zaed Z. R. Hamady (Department of HPB Surgery, University Hospital Southampton NHS Foundation Trust) ;
  • Bilal Al-Sarrieh (Department of HPB Surgery, Swansea Bay University Health Board) ;
  • Alejandro Serrablo (Department of HPB Surgery, Hospital Universitario Miguel Servet) ;
  • Somaiah Aroori (Department of HPB Surgery, University Hospitals Plymouth NHS Trust)
  • Received : 2023.06.09
  • Accepted : 2023.07.26
  • Published : 2024.02.29
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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.

Keywords

Acknowledgement

We wish to thank all those who contributed towards the RAW study. This manuscript was previously posted to bioRxiv: https://www.researchsquare.com/article/rs-2084792/v1. The findings of this paper were presented as an oral presentation at the National Research Collaborative Meeting 2023 (Cardiff, UK) and as a poster at the PSGBI Annual Scientific Meeting 2023 (Leeds, UK).

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