Abstract
Numerous strategies for perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95% CI 0.02~0.72), Preop-IM (OR 0.22; 95% CI 0.08~0.62), and Preop-IM plus Postop-IM (OR 0.11; 95% CI 0.03~0.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95% CI 0.19~0.71) and Preop-IM plus Postop-IM (OR 0.21; 95% CI 0.06~0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.
Highlights
Pancreaticoduodenectomy (PD) is one of the most extensive and radical surgical procedures for periampullary tumors
Studies were included according to the following criteria: patients receiving PD or pylorus-preserving PD (PPPD) with nutrition therapy as an intervention for clinical outcome comparison
Only nine eligible randomized controlled trials (RCTs) were included for the subsequent analysis [6,16,17,18,19,20,21,22,23]
Summary
Pancreaticoduodenectomy (PD) is one of the most extensive and radical surgical procedures for periampullary tumors. Patients may be prevented from obtaining nutrition orally or even via gastric tubes due to surgical complications. The incidence of PD-related complications has been reported to range from 20% to 30%, and the incidence of insufficiency of pancreaticojejunostomy, namely, postoperative pancreatic fistula (POPF), ranges from 14%. Perioperative nutrition therapy has been recognized as critical for facilitating patient recovery from surgical stress, the management of surgical complications, and long-term patient outcomes after pancreatic surgery [3]. In addition to the meticulous assessment of nutritional risk, perioperative selection among various nutritional formulas and routes of nutrition administration are important considerations for clinicians. We investigated whether any specific nutrition therapy is superior in terms of PD surgery complications. We focused on common surgical complications, and the most important and specific complication related to PD, postoperative pancreatic fistula (POPF). We systematically reviewed all the searchable evidence and used the traditional network meta-analysis (NMA) and component network meta-analysis (cNMA) techniques to conclude the best evidence from the eligible randomized control trials (RCTs)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
