Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
HPB (Oxford). 2022 Oct;24(10):1615-1621. doi: 10.1016/j.hpb.2022.04.005. Epub 2022 Apr 26.
The effect of early oral feeding (EOF) after pancreatoduodenectomy (PD) upon perioperative complications and outcomes is unknown, therefore the aim of this systematic review and meta-analysis was to investigate the effect of EOF on clinical outcomes after PD, such as postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and length of stay (LOS).
A systematic review and meta-analysis was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and assimilated evidence from studies reporting outcomes for patients who received EOF after PD compared to enteral tube feeding (EN) or parenteral nutrition (PN).
Four studies reported outcomes after EOF compared to EN/PN after PD and included 553 patients. Meta-analyses showed no difference in rates of CR-POPF (OR 0.74; 95%CI 0.44-1.24; p = 0.25) or DGE (Grade B/C) (OR 0.83; 95%CI 0.31-2.21; p = 0.70). LOS was significantly shorter in the EOF group compared to the EN/PN group (Mean Difference -3.40 days; 95% -6.11-0.70 days; p = 0.01).
Current available evidence suggests that EOF after PD is not associated with increased risk of DGE, does not exacerbate POPF and appears to reduce length of stay.
胰十二指肠切除术（PD）后早期口服喂养（EOF）对围手术期并发症和结局的影响尚不清楚，因此本系统评价和荟萃分析的目的是研究 EOF 对 PD 后临床结局的影响，如术后胰瘘（POPF）、胃排空延迟（DGE）和住院时间（LOS）。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价和荟萃分析，并综合了报告接受 PD 后 EOF 与肠内管饲（EN）或肠外营养（PN）相比的患者结局的研究证据。
四项研究报告了 EOF 与 PD 后 EN/PN 相比的结局，共纳入 553 例患者。荟萃分析显示，CR-POPF 发生率（OR 0.74；95%CI 0.44-1.24；p=0.25）或 DGE（B/C 级）（OR 0.83；95%CI 0.31-2.21；p=0.70）无差异。EOF 组的 LOS 明显短于 EN/PN 组（Mean Difference-3.40 天；95%CI-6.11-0.70 天；p=0.01）。
目前可用的证据表明，PD 后 EOF 不会增加 DGE 的风险，不会加重 POPF，似乎可以缩短住院时间。
