Bozzetti Federico, Mariani Luigi
Faculty of Medicine, University of Milan, Milan, Italy.
Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Nutrition. 2014 Nov-Dec;30(11-12):1267-71. doi: 10.1016/j.nut.2014.03.002. Epub 2014 Mar 14.
The results achieved through the Enhanced Recovery After Surgery (ERAS) approach in gastrointestinal surgery have led to its enthusiastic acceptance in pancreatic surgery. However, the ERAS program also involves an early oral feeding that is not always feasible after pancreatoduodenectomy. The aim of this review was to investigate in the literature whether the difficulty with early oral feeding in these patients was adequately balanced by perioperative enteral or parenteral nutritional support as recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines or whether these recommendations have lost value in the "bundle" of the ERAS.
We reanalyzed both ESPEN guidelines and literature regarding the ERAS program in surgical pancreatic patients.
There was a high prevalence of malnutrition (and consequently of postoperative complications) in patients with pancreatic cancer, and there is evidence that many of these patients should be candidates for perioperative nutritional support according to ESPEN guidelines. The start of oral fluid and solid feeding was quite variable in literature reporting the use of ERAS in pancreatic cancer surgery, with a consistent gap between the recommended and the effective start of both the feedings. The use of nasogastric/jejunal tube or of a needle-catheter jejunostomy was discouraged by the ERAS guidelines but their use could prove beneficial in patients who are recognized at high risk for postoperative complications according to the scores available in the literature.
The current practice of the ERAS program in these patients appears to neglect some ESPEN recommendations. On the other hand, both ESPEN and ERAS recommendations could be combined for a supplemental benefit for the patient.
通过外科手术加速康复（ERAS）方法在胃肠手术中取得的成果，使其在胰腺手术中得到了广泛应用。然而，ERAS方案还包括早期经口进食，而这在胰十二指肠切除术后并不总是可行的。本综述的目的是在文献中研究，这些患者早期经口进食的困难是否能通过欧洲临床营养和代谢学会（ESPEN）指南推荐的围手术期肠内或肠外营养支持得到充分平衡，或者这些建议在ERAS“套餐”中是否已失去价值。
我们重新分析了ESPEN指南以及关于外科胰腺患者ERAS方案的文献。
胰腺癌患者中营养不良（以及术后并发症）的发生率很高，并且有证据表明，根据ESPEN指南，这些患者中的许多人都应接受围手术期营养支持。在报道胰腺癌手术中使用ERAS的文献中，口服液体和固体食物的开始时间差异很大，推荐的和实际开始的时间之间始终存在差距。ERAS指南不鼓励使用鼻胃管/空肠管或针导管空肠造口术，但根据文献中的评分，对于被认为术后并发症高风险的患者，使用这些方法可能有益。
目前在这些患者中实施的ERAS方案似乎忽视了一些ESPEN建议。另一方面，ESPEN和ERAS的建议可以结合起来，为患者带来额外的益处。
