The effect of early supplemental parental nutrition in patients after pancreaticoduodenectomy

Abstract Background/OBJECTIVES: Pancreaticoduodenectomy (PD) has multi-potential factors for malnutrition as its surgical boundary covers organs with digestive juices. The utility of supplemental parental nutrition (PN) is controversial for patients underwent PD. This study aimed to investigate clinical effect of using routine supplemental-PN after PD.SUBJECTS/Methods: From 2014 to 2020, 927 patients undergoing PD in Samsung Medical Center were divided into two groups, those who used routine supplemental-PN (n = 161) and those who did not (n = 766) and analyzed retrospectively. The routine supplemental-PN was administered to patients by using PN with oral feeding together, started after immediate postoperative 1–3 days without interruption. A subgroup analysis was performed for patients with diabetes mellitus (DM) and sarcopenia.Results Regarding postoperative complications, the supplemental-PN group had significantly higher rates of postoperative pancreatic fistula (POPF) (p < 0.001) and delayed gastric emptying (p = 0.012) than the non-PN group. The supplemental-PN group had similar hospital stay to the non-PN group (p = 0.547). In subgroup analysis for those with DM (n = 252), the supplemental-PN group had significantly higher postoperative major complications (37.5 vs. 20.6%, p = 0.016), especially POPF (27.1 vs. 10.8%, p = 0.006), than the non-PN group. For sarcopenic patients (n = 89), the supplemental-PN group had significantly longer hospital stay than the non-PN group (13.7 days vs. 11.4 days, p = 0.040).Conclusion In terms of postoperative complications, routine use of supplemental-PN after PD is not beneficial for patients. Especially with DM and sarcopenia, its use needs caution.