Complications of pancreatic surgery and the role of perioperative nutrition

Background: According to international guidelines, artificial nutrition may be indicated after pancreaticoduodenectomy (PD). This clinical study was d esigned to evaluate whether the route of administration and the composition of the postoperative nutritional support could affect outcome. Methods: On e hundred patients who underwent PD for cancer of the pancreatic head were prospectively studied. Patients were randomized to receive a standard enter al formula (SEN; n = 35) or immunonutrition with an enteral formula enriche d with arginine, omega-3 fatty acids, and RNA (IEN group; n = 33), or total parenteral nutrition (TPN; n = 32). Postoperative feeding was started with in 12 h after surgery. The three regimens were isoenergetic and isonitrogen ous. Tolerance of enteral feeding, rate and severity of postoperative compl ications, and length of hospital stay (LOS) were evaluated. Results: Full n utritional goal (25 kcal/kg) was achieved in 84% of enterally fed patients versus 96% in the parenteral group (p = NS). The rate of postoperative comp lications was lower in the IEN group (33%) than in the SEN (40%) and TPN gr oups (59%). The severity of infectious complications (sepsis score) was low er in the IEN (5.5) than the SEN (7.9)and TPN groups (10.4; p < 0.05). LOS was shorter in the IEN than in the SEN and TPN groups (16.3 vs. 17.8 vs. 19 .3 days, respectively; p < 0.05). Conclusions: In patients undergoing PD th e; established nutritional goal can be obtained by enteral feeding. Immunon utrition seems to improve outcome.