SP2.7 Is routine nasogastric tube placement following pancreatoduodenectomy really necessary?

Abstract

Abstract Background Traditionally, pancreatoduodenectomy (PD) patients would leave theatre with a nasogastric tube (NGT) in situ. Recent evidence has suggested that the potential drawbacks of routine placement may outweigh the potential gains. This study aimed to compare the outcomes of PD patients who received a NGT intra-operatively to those did not. Methods Data taken from Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres from 8 countries, n=1484). The following outcome measures were used: median length of stay (LoS), incidence of delayed gastric emptying (DGE), incidence of grade B/C DGE, and the provision of postoperative nutritional support. Analyses were performed using Fisher’s exact test and the Mann-Whitney U test. Results Out of 1484 patients who underwent PD for malignancy, 1098 (74.0%) had data on their NGT status. 91.6% of patients received an intra-operative NGT. The median length of time until tube removal was four days (range: 1-64, interquartile range: 3). in comparison to the group with no NG tube, median length of stay (both 14 days, p=0.9), as well as incidence of DGE (14.3% vs 7.6%, p=0.08) grade B/C DGE (8.3% vs 4.3%, p=0.2) were similar. Patients who did not receive a tube less often received postoperative nutritional support (any form, 30.4% vs 49.8%, p=0.0004). Conclusion Most patients underwent PD had NG placed intraoperatively. Had no affect length of stay or incidence of DGE. Patients who received a NGT more often received postoperative nutritional support. NGTs should only be placed when they are clinically indicated.