Objective:

To evaluate the impact of early supplemental enteral nutrition on postoperative complications specifically in patients at nutritional risk undergoing pancreatoduodenectomy.

Approach:

Key Findings:

• Mean Comprehensive Complication Index score was significantly lower in the enteral nutrition group (25.5) compared to the oral nutrition group (35.8; P=.02).
• Overall morbidity rates were similar between groups (76% vs 86%).
• Major complications occurred in 27% of the enteral nutrition group vs 44% of the oral nutrition group (P=.06).
• Infectious complications were lower in the enteral nutrition group (20% vs 37%; P=.04).
• Pulmonary complications were also lower in the enteral nutrition group (5% vs 19%; P=.02).
• Approximately half of patients in both groups required supplemental parenteral nutrition.

Interpretation:

Early enteral nutrition was safe and well tolerated, showing a lower burden of complications primarily due to reduced infectious and pulmonary events, but did not significantly decrease the overall complication rates.

Limitations:

• Trial heavily center-dependent with 80% of patients from a single site, limiting generalizability.
• Nonblinded design may have influenced observed differences.
• Postoperative physiology and delayed gastric emptying affected comparisons.

Conclusion:

Early supplemental enteral nutrition is associated with a lower overall burden of complications in high-risk patients undergoing pancreatoduodenectomy, but requires careful implementation and does not reduce the proportion of patients with complications, especially considering the need for concurrent parenteral nutrition.

Sources:

• JAMA Surgery
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