Routes of nutrition for pancreatic fistula after pancreatoduodenectomy: a prospective snapshot study identifies the need for therapy standardization.
Enteral
Nutrition
Pancreatic fistula
Pancreatoduodenectomy
Parenteral
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
27
10
2022
accepted:
22
03
2023
medline:
18
8
2023
pubmed:
13
4
2023
entrez:
12
4
2023
Statut:
ppublish
Résumé
The aim of this study is to describe the current utilization of artificial nutrition [enteral (EN) or total parenteral (TPN)] for pancreatic fistula (POPF) after pancreatoduodenectomy (PD). Prospective data of 311 patients who consecutively underwent PD at a tertiary referral center for pancreatic surgery were collected. Data included the use of EN or TPN specifically for POPF treatment, including timing, outcomes, and adverse events related to their administration. POPF occurred in 66 (21%) patients and 52 (79%) of them were treated with artificial nutrition, for a median of 36 days. Forty (76%) patients were treated with a combination of TPN and EN. The median day of artificial nutrition start was postoperative day 7, with a median drain output of 180 cc/24 h. In 33 (63%) patients, artificial nutrition was started while only a biochemical leak was ongoing. Fungal infections and catheter-related bloodstream infection occurred in 13 (28%) and 15 (33%) TPN patients, respectively; among EN patients, 19 (41%) experienced diarrhea not responsive to pancreatic enzymes and 9 (20%) needed multiple endoscopic naso-jejunal tube positioning. The majority of the patients developing POPF after PD were treated with a combination of TPN and EN, with a clinically relevant rate of adverse events related to their administration. Standardization of nutrition routes in patients developing POPF is urgently needed.
Identifiants
pubmed: 37046060
doi: 10.1007/s13304-023-01501-y
pii: 10.1007/s13304-023-01501-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1431-1438Informations de copyright
© 2023. Italian Society of Surgery (SIC).
Références
Sánchez-Velázquez P, Muller X, Malleo G et al (2019) Benchmarks in pancreatic surgery: a novel tool for unbiased outcome comparisons. Ann Surg 270(2):211–218. https://doi.org/10.1097/SLA.0000000000003223
doi: 10.1097/SLA.0000000000003223
pubmed: 30829701
Marchegiani G, Perri G, Burelli A et al (2021) High-risk pancreatic anastomosis vs. total pancreatectomy after pancreatoduodenectomy: postoperative outcomes and quality of life analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000004840
doi: 10.1097/SLA.0000000000004840
pubmed: 33938491
Gianotti L, Besselink MG, Sandini M et al (2018) Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery 164(5):1035–1048. https://doi.org/10.1016/j.surg.2018.05.040
doi: 10.1016/j.surg.2018.05.040
pubmed: 30029989
Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591. https://doi.org/10.1016/j.surg.2016.11.014
doi: 10.1016/j.surg.2016.11.014
pubmed: 28040257
Klek S, Sierzega M, Turczynowski L, Szybinski P, Szczepanek K, Kulig J (2011) Enteral and parenteral nutrition in the conservative treatment of pancreatic fistula: a randomized clinical trial. Gastroenterology 141(1):157–163. https://doi.org/10.1053/j.gastro.2011.03.040 . (163.e1)
doi: 10.1053/j.gastro.2011.03.040
pubmed: 21439962
Wu JM, Kuo TC, Chen HA et al (2019) Randomized trial of oral versus enteral feeding for patients with postoperative pancreatic fistula after pancreatoduodenectomy. Br J Surg 106(3):190–198. https://doi.org/10.1002/bjs.11087
doi: 10.1002/bjs.11087
pubmed: 30724356
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25. https://doi.org/10.1016/j.surg.2007.02.001
doi: 10.1016/j.surg.2007.02.001
pubmed: 17629996
Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768. https://doi.org/10.1016/j.surg.2007.05.005
doi: 10.1016/j.surg.2007.05.005
pubmed: 17981197
Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149(5):680–688. https://doi.org/10.1016/j.surg.2010.12.002
doi: 10.1016/j.surg.2010.12.002
pubmed: 21316725
Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810. https://doi.org/10.1001/jama.2016.0287
doi: 10.1001/jama.2016.0287
pubmed: 26903338
pmcid: 4968574
Andrianello S, Marchegiani G, Malleo G et al (2020) Pancreaticojejunostomy with externalized stent vs pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3, randomized clinical trial. JAMA Surg 155(4):313–321. https://doi.org/10.1001/jamasurg.2019.6035
doi: 10.1001/jamasurg.2019.6035
pubmed: 32101272
Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002
doi: 10.1016/j.jamcollsurg.2012.09.002
pubmed: 23122535
Salvia R, Marchegiani G, Andrianello S et al (2020) Redefining the role of drain amylase value for a risk-based drain management after pancreaticoduodenectomy: early drain removal still is beneficial. J Gastrointest Surg. https://doi.org/10.1007/s11605-020-04658-8
doi: 10.1007/s11605-020-04658-8
pubmed: 32495136
Practice Guidelines for Central Venous Access (2012) A report by the American Society of Anesthesiologists Task Force on central venous access. Anesthesiology 116(3):539–573. https://doi.org/10.1097/ALN.0b013e31823c9569
doi: 10.1097/ALN.0b013e31823c9569
Mermel LA, Allon M, Bouza E et al (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1–45. https://doi.org/10.1086/599376
doi: 10.1086/599376
pubmed: 19489710
Perri G, Marchegiani G, Partelli S et al (2021) Preoperative risk stratification of postoperative pancreatic fistula: a risk-tree predictive model for pancreatoduodenectomy. Surgery. https://doi.org/10.1016/j.surg.2021.06.046
doi: 10.1016/j.surg.2021.06.046
pubmed: 34338460
O’Keefe SJD (2006) Physiological response of the human pancreas to enteral and parenteral feeding. Curr Opin Clin Nutr Metab Care 9(5):622–628. https://doi.org/10.1097/01.mco.0000241675.63041.ca
doi: 10.1097/01.mco.0000241675.63041.ca
pubmed: 16912561
O’Keefe SJD, Lee RB, Anderson FP et al (2003) Physiological effects of enteral and parenteral feeding on pancreaticobiliary secretion in humans. Am J Physiol Gastrointest Liver Physiol 284(1):G27-36. https://doi.org/10.1152/ajpgi.00155.2002
doi: 10.1152/ajpgi.00155.2002
pubmed: 12488233
Maljaars PWJ, Peters HPF, Mela DJ, Masclee AAM (2008) Ileal brake: a sensible food target for appetite control. A review. Physiol Behav 95(3):271–281. https://doi.org/10.1016/j.physbeh.2008.07.018
doi: 10.1016/j.physbeh.2008.07.018
pubmed: 18692080
Fujii T, Nakao A, Murotani K et al (2015) Influence of food intake on the healing process of postoperative pancreatic fistula after pancreatoduodenectomy: a multi-institutional randomized controlled trial. Ann Surg Oncol 22(12):3905–3912. https://doi.org/10.1245/s10434-015-4496-1
doi: 10.1245/s10434-015-4496-1
pubmed: 25777090