Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China.
Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Suqian, China.
J Invest Surg. 2021 Jun;34(6):575-582. doi: 10.1080/08941939.2019.1663378. Epub 2019 Sep 18.
Early oral intake is strongly recommended according to the enhanced recovery after surgery (ERAS) guidelines because it can reduce complications and improve recovery. However, early oral intake has been indicated to be associated with chyle leakage (CL) after pancreatic surgery, which may lead to worsening of existing malnutrition and impeded recovery. This study investigated the relationship between early oral intake and CL and identified risk factors for CL to reduce its occurrence and promote recovery after pancreaticoduodenectomy.
All patients who underwent pancreaticoduodenectomy between June 2014 and June 2018 were identified retrospectively. Patients were divided into the early-oral-intake and control groups according to whether they had early oral intake according to ERAS protocols. CL and other clinicopathological characteristics were recorded. Univariable and multivariable analyses assessed CL risk factors.
Early oral intake improved recovery, leading to a shorter postoperative hospital stay for the early-oral-intake group in comparison to that of the control group [13.6 (range, 12-68) vs. 17.8 (range, 14-83) days; = 0.047] without increasing the incidence of CL and other complications. CL was diagnosed significantly earlier in the early-oral-intake group than in the control group [4.6 (range 3-5) vs. 6.7 (range 3-9) days; = 0.001]. Early oral intake did not increase the grade severity ( = 0.845) or the costs ( = 0.241) or prolong postoperative hospital stays ( = 0.611). A primary diagnosis of malignancy, para-aortic lymph node dissection, lymphatic invasion, lymph node metastases, the number of harvested nodes, and the number of positive nodes were significantly associated with CL ( < 0.05), whereas early oral intake was not ( = 0.525). Multivariate analyses demonstrated that para-aortic lymph node dissection ( = 0.039) and the number of harvested nodes ( = 0.001) were independent risk variables.
This study provides significant evidence that early oral intake after pancreaticoduodenectomy is not associated with CL. The identification of the independent risk factors for CL can help prevent it.
根据加速康复外科（ERAS）指南，强烈建议早期口服摄入，因为它可以减少并发症并促进恢复。然而，早期口服摄入与胰腺手术后的乳糜漏（CL）有关，这可能导致现有的营养不良恶化和恢复受阻。本研究调查了早期口服摄入与 CL 的关系，并确定了 CL 的危险因素，以减少其发生并促进胰十二指肠切除术后的恢复。
回顾性地确定了 2014 年 6 月至 2018 年 6 月期间接受胰十二指肠切除术的所有患者。根据是否根据 ERAS 方案进行早期口服摄入，将患者分为早期口服摄入组和对照组。记录 CL 和其他临床病理特征。单变量和多变量分析评估 CL 的危险因素。
早期口服摄入改善了恢复，使早期口服摄入组的术后住院时间比对照组更短[13.6（范围 12-68）与 17.8（范围 14-83）天；=0.047]，而没有增加 CL 和其他并发症的发生率。CL 在早期口服摄入组中被诊断的时间明显早于对照组[4.6（范围 3-5）与 6.7（范围 3-9）天；=0.001]。早期口服摄入并没有增加严重程度的等级（=0.845）或成本（=0.241）或延长术后住院时间（=0.611）。恶性肿瘤的主要诊断、腹主动脉旁淋巴结清扫术、淋巴血管侵犯、淋巴结转移、采集的淋巴结数量和阳性淋巴结数量与 CL 显著相关（<0.05），而早期口服摄入则没有（=0.525）。多变量分析表明，腹主动脉旁淋巴结清扫术（=0.039）和采集的淋巴结数量（=0.001）是独立的危险因素。
本研究提供了重要证据，表明胰十二指肠切除术后的早期口服摄入与 CL 无关。确定 CL 的独立危险因素有助于预防 CL。
