Impact of foregoing a nasogastric tube in robotic pancreaticoduodenectomy: a propensity score-matched study

Abstract Nasogastric tube (NGT) placement has been standard practice in pancreatoduodenectomy, but also questioned. This study evaluated the feasibility and safety of foregoing a NGT in robotic pancreatoduodenectomy (RPD). A total of 906 patients undergoing RPD or open pancreatoduodenectomy (OPD) were included in this study for propensity score matching. Study group of RPD without a NG tube (RPD(-)NGT) was compared with those of RPD with a NG tube (RPD(+)NGT) and OPD with a NG tube (OPD(+)NGT). Each arm comprised 100 patients. The RPD groups without and with NGT had less intraoperative blood loss compared to the OPD group, with a median of 155 vs. 200 vs. 500 cc (p < 0.001) and a higher lymph node yield, with a median number of 18 vs. 15 vs. 12 (p < 0.001). The surgical outcomes were comparable among the RPD(-)NGT, RPD(+)NGT, and OPD(+)NGT groups, except for delayed gastric emptying (DGE) and length of stay (LOS). The incidence of DGE was significantly lower in the RPD without and with NGT groups than in the OPD(+)NGT group (3% vs. 4% vs. 18%, p < 0.001). The LOS was also shorter in the RPD(-)NGT group, with a median of 17 days, compared to the other two groups with NGT, 22 days and 26 days (p < 0.001). Only operation type, OPD, remained an independent risk factor for predicting the occurrence of DGE. RPD without NGT was associated with lower DGE and shorter LOS. It is feasible to forego a NGT in RPD cases without negative impact on safety.