Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
J Gastrointest Surg. 2020 Jul;24(7):1597-1604. doi: 10.1007/s11605-019-04316-8. Epub 2019 Jul 19.
In the era of fast-track surgery, because pancreaticoduodenectomy (PD) carries a significant morbidity, surgeons hesitate to begin early oral feeding and achieve early discharge. We compared the outcome of two different approaches to the postoperative management of PD in two tertiary centers.
Of patients having undergone PD for malignancy from 2008 to 2017, 100 patients who received early postoperative oral feeding (group A) were compared to 100 patients from another center who received early enteral feeding and a delayed oral diet (group B). Surgical indication and approach and type of pancreatic anastomosis were similar between both groups. Postoperative outcomes were retrospectively reviewed.
Patient characteristics were similar between both groups, except significantly more neoadjuvant treatment in group A (A = 20% vs. B = 9%, p < 0.01). Mortality rates were 3% and 4% in groups A and B, respectively (p = 0.71). The rate of severe postoperative morbidity was significantly lower in group A (13% vs. 26%, p = 0.02), resulting in a lower reoperation rate (p < 0.01). Delayed gastric emptying and clinically relevant pancreatic fistula were similar between both groups but chyle leaks were more frequent in group A (10% vs. 3%, p = 0.04). The median hospital stay was shorter in group A (16 vs. 20 days, p < 0.01).
In the present study, early postoperative oral feeding after PD was associated with a shorter hospital stay and did not increase severe postoperative morbidity or the rate of pancreatic fistula. However, it resulted in more chyle leaks and did not prevent delayed gastric emptying.
在快速通道手术时代，由于胰十二指肠切除术（PD）具有较高的发病率，因此外科医生在开始进行早期口服喂养和实现早期出院方面犹豫不决。我们比较了在两个三级中心中两种不同 PD 术后管理方法的结果。
对 2008 年至 2017 年间因恶性肿瘤而行 PD 的患者，将 100 例接受早期术后口服喂养（A 组）的患者与另一中心的 100 例接受早期肠内喂养和延迟口服饮食的患者（B 组）进行比较。两组的手术适应证、手术方式和胰腺吻合术类型均相似。回顾性分析术后结果。
两组患者的一般特征相似，但 A 组的新辅助治疗明显更多（A 组为 20%，B 组为 9%，p < 0.01）。A 组和 B 组的死亡率分别为 3%和 4%（p = 0.71）。A 组严重术后发病率明显较低（13% vs. 26%，p = 0.02），导致再次手术率较低（p < 0.01）。A 组和 B 组的延迟胃排空和临床相关胰瘘发生率相似，但 A 组的乳糜漏更常见（10% vs. 3%，p = 0.04）。A 组的中位住院时间更短（16 天 vs. 20 天，p < 0.01）。
在本研究中，PD 后早期口服喂养与缩短住院时间相关，且不会增加严重术后发病率或胰瘘发生率。但是，它导致更多的乳糜漏，且不能预防胃排空延迟。
