Early Enteral Versus Total Parenteral Nutrition in Patients Undergoing Pancreaticoduodenectomy: A Randomized Multicenter Controlled Trial (Nutri-DPC)

Autor: Gainant A, Sylvie Bin-Dorel, Mustapha Adham, Julie Perinel, Alain Sauvanet, Marc Pocard, Emmanuel Buc, Lorraine Bernard, Michel El Bechwaty, Jean-Yves Mabrut, Christophe Mariette, Dominique Delaunay, Igor Sielezneff, Bertrand Dousset
Přispěvatelé: Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Chirurgie générale et Digestive, Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille, Service d'oncologie digestive et hépato-gastro-entérologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Vascular research center of Marseille (VRCM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie de l'Endothelium, Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Timone [CHU - APHM] (TIMONE), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Equipe de Recherche Médicale Appliquée (ERMA), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Chirurgie générale et digestive, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Santé Individu Société (SIS), Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de thermocinétique [Nantes] (LTN), Université de Nantes (UN)-Centre National de la Recherche Scientifique (CNRS), Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Clermont-Ferrand, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Santé Individu Société - SIS (SIS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université Lumière - Lyon 2 (UL2), Centre National de la Recherche Scientifique (CNRS)-Université de Nantes (UN), Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), DIGNAT-GEORGE, Françoise
Rok vydání: 2016
Předmět:
Male
postoperative outcomes
Fistula
medicine.medical_treatment
[SDV]Life Sciences [q-bio]
INTERNATIONAL STUDY-GROUP
030230 surgery
Enteral administration
Gastroenterology
law.invention
0302 clinical medicine
Postoperative Complications
Randomized controlled trial
law
Medicine
Prospective Studies
Prospective cohort study
COMPLICATIONS
Middle Aged
Pancreaticoduodenectomy
FISTULA
3. Good health
[SDV] Life Sciences [q-bio]
GASTROINTESTINAL SURGERY
Treatment Outcome
Pancreatic fistula
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Female
Parenteral Nutrition
Total
medicine.medical_specialty
PANCREATIC SURGERY ISGPS
parenteral nutrition
CANCER-PATIENTS
CLINICAL-TRIAL
03 medical and health sciences
Enteral Nutrition
Internal medicine
Humans
In patient
PERIOPERATIVE CARE
METAANALYSIS
Aged
Postoperative Care
Gastric emptying
Hepatology
business.industry
General surgery
Recovery of Function
Length of Stay
medicine.disease
Pancreatic Neoplasms
Parenteral nutrition
RISK-FACTORS
Surgery
business
Zdroj: Annals of Surgery
Annals of Surgery, 2016, 264, pp.731-737
Annals of Surgery, Lippincott, Williams & Wilkins, 2016, 264, pp.731-737
ISSN: 1528-1140
0003-4932
Popis: The aim of this study was to compare nasojejunal early enteral nutrition (NJEEN) with total parenteral nutrition (TPN), after pancreaticoduodenectomy (PD), in terms of postoperative complications.
Current nutritional guidelines recommend the use of enteral over parenteral nutrition in patients undergoing gastrointestinal surgery. However, the NJEEN remains controversial in patients undergoing PD.
Multicenter, randomized, controlled trial was conducted between 2011 and 2014. Nine centers in France analyzed 204 patients undergoing PD to NJEEN (n = 103) or TPN (n = 101). Primary outcome was the rate of postoperative complications according to Clavien-Dindo classification. Successful NJEEN was defined as insertion of a nasojejunal feeding tube, delivering at least 50% of nutritional needs on PoD 5, and no TPN for more than consecutive 48 hours.
Postoperative complications occurred in 77.5% [95% confidence interval (95% CI) 68.1-85.1] patients in the NJEEN group versus 64.4% (95% CI 54.2-73.6) in TPN group (P = 0.040). NJEEN was associated with higher frequency of postoperative pancreatic fistula (POPF) (48.1% vs 27.7%, P = 0.012) and higher severity (grade B/C 29.4% vs 13.9%; P = 0.007). There was no significant difference in the incidence of post-pancreatectomy hemorrhage, delayed gastric emptying, infectious complications, the grade of postoperative complications, and the length of postoperative stay. A successful NJEEN was achieved in 63% patients. In TPN group, average energy intake was significantly higher (P < 0.001) and patients had an earlier recovery of oral feeding (P = 0.0009).
In patients undergoing PD, NJEEN was associated with an increased overall postoperative complications rate. The frequency and the severity of POPF were also significantly increased after NJEEN. In terms of safety and feasibility, NJEEN should not be recommended.
Databáze: OpenAIRE
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