Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan.
Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City 333, Taiwan.
Nutrients. 2021 Nov 12;13(11):4049. doi: 10.3390/nu13114049.
Numerous strategies for perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95% CI 0.020.72), Preop-IM (OR 0.22; 95% CI 0.080.62), and Preop-IM plus Postop-IM (OR 0.11; 95% CI 0.030.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95% CI 0.190.71) and Preop-IM plus Postop-IM (OR 0.21; 95% CI 0.06~0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.
已经提出了许多用于胰十二指肠切除术（PD）患者围手术期营养治疗的策略。本系统评价旨在通过传统网络荟萃分析（NMA）和成分网络荟萃分析（cNMA）总结当前评估不同营养干预措施的相关随机对照试验（RCT）。检索了 EMBASE、MEDLINE、Cochrane 图书馆和 ClinicalTrials.gov 以确定 RCT。评估的营养干预措施包括经饲管的术后标准肠内营养（Postop-SEN）、术前肠内喂养（Preop-EN）、术后免疫营养素（Postop-IM）、术前口服免疫营养素补充剂（Preop-IM）和术后全肠外营养（TPN）。主要结局为一般、感染和非感染性并发症、术后胰瘘（POPF）和胃排空延迟（DGE）。次要结局为死亡率和住院时间（LOS）。采用似然比法进行 NMA 和 cNMA。结果表示为比值比（OR）和 95%置信区间（CI）。营养干预措施对两个主要结局，即感染性并发症和 POPF，具有积极影响。Preop-EN 加 Postop-SEN（OR 0.11；95%CI 0.020.72）、Preop-IM（OR 0.22；95%CI 0.080.62）和 Preop-IM 加 Postop-IM（OR 0.11；95%CI 0.030.37）均与感染性并发症的减少相关。Postop-TPN（OR 0.37；95%CI 0.190.71）和 Preop-IM 加 Postop-IM（OR 0.21；95%CI 0.06~0.77）均有益于预防 POPF。虽然肠内喂养和 TPN 可能分别降低感染性并发症和 POPF 的发生率，但 Preop-IM 加 Postop-IM 可能为 PD 患者提供最佳的临床获益，因为这种方法降低了上述两种不良反应的发生率。
