HPB P13 A Systematic Review of the Methodology Used in Nutritional Effectiveness Trials for Pancreatoduodenectomy Patients

Abstract

Abstract Background Malnutrition is highly prevalent amongst pancreatoduodenectomy (PD) patients and remains a major modifiable risk factor for postoperative morbidity and mortality. As a result, there is a need to identify optimal nutritional therapies but this has typically been difficult due to multiple methodological issues including lack of suitable control group and outcome. Therefore, the aim of this review is to report and compare the administration of different nutritional therapies as well as reporting of nutritional outcomes in randomised controlled trials (RCTs) of PD patients. Methods A systematic review of randomised controlled trials (RCTs) studies reporting the effect of different nutritional interventions after PD was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase and Medline databases were searched. The search identified 21 suitable studies for inclusion. Results There were 5 different feeding routes reported, with oral diet (14 studies, 67%) and parenteral nutrition (9 studies, 43%) being the most common. There was widespread variation in when oral diet was started, ranging between postoperative day (POD) 1 and 7. Regarding enteral tube feeding, multiple different feed types were used and feed administration was highly variable, for both rate and duration. In terms of outcome types, 17 (81%) studies reported biochemical outcomes with serum albumin being the most common (12 studies, 57%) and 12 (57%) reported anthropometric outcomes with body mass index the most common (7 studies, 33%). Conclusions Amongst the published RCTs investigating the effect of different nutritional routes after PD, widespread variation in the methodology was evident. This has implications for both interpretation of results and for design of future nutritional trials. Multiple biochemical and anthropometric outcomes were reported but quality of life measures, such as the SF-36 recommended by a recently published core outcome set, were not used.