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Background: Nutrition support have undergone total parenteral nutrition (TPN) in postoperative patients in decades, Recent studies have elaborated that early enteral nutrition (EEN) have advantages in reducing the incidence of postoperative complications, however, Some studies have claimed that EEN is insignificant or even negative in decreasing complication morbidity rates after abdominal surgery;  thus, the role of EN remains debatable. However, current evidence is limited and controversial. To determine the safety and effectiveness of EN for patients after PD, we therefore performed an up-to-date meta-analysis to EN versus PN routes after pancreaticoduodenectomy including all randomized clinical trials .

Methods: Eligible studies in the PUBMED, the Cochrane Library and Embase were retrieved. Fixed-effect model or random-effects model was used via State 12.0 software, and P<0.05 indicated statistical significance. Calculation for dichotomous variables was carried out using the risk ratio (RR) and their 95% CI as the summary statistic.

Results: Six randomized controlled trial with 866 patients were included, in which 435 patients underwent early EN and 431 patients underwent parenteral nutrition routes following PD. In the EN versus PN routes, the postoperative Nutritional Index the level of serum albumin increased in the late postoperative days, and there is significant difference between two groups(mean difference, -0.29; 95 % CI, −0.47 to -0.11; P=0.002), and there is significant difference in hospital stay (mean difference, -0.29; 95 % CI, −0.56 to -0.02; P=0.038), but no significant difference could be found in delayed gastric emptying ( relative risk (RR) 0.94; 95 % CI, 0.71–1.24; P=0.66), postoperative infection( relative risk (RR) 0.88; 95 % CI, 0.68–1.13; P=0.31), pancreatic fistulas ( relative risk (RR) 1.22; 95 % CI, 0.88–1.70; P=0.231), gastrointestinal bleeding( relative risk (RR) 0.83; 95 % CI, 0.55–1.25; P=0.37), mortality( relative risk (RR) 1.41; 95 % CI, 0.61–3.23; P=0.423).

Conclusions: Our results revealed that EN has advantages in improving early term postoperative nutritional status, reducing hospital stay, and postoperative EN is safe and well tolerated, and shows no negative effect on postoperative complications. It is recommended that the routine postoperative enteral nutrition for patients undergoing PD is beneficial. Future large-scale, high-quality, multicenter trials are still required to clarify the issues of EN in patients undergoing PD.