Hendriks Tessa E, Strijbos Bo T M, Francken Michiel F G, Ali Mahsoem, Suurmeijer J Annelie, Dijkgraaf Marcel G W, Hopstaken Jana S, van Laarhoven Kees, Molenaar Quintus, de Meijer Vincent E, van der Harst Erwin, den Dulk Marcel, Draaisma Werner, Nieuwenhuijs Vincent, Gerhards Michael F, Liem Mike S L, van der Schelling George, Manusama Eric, de Hingh Ignace, van Santvoort Hjalmar, Groot Koerkamp Bas, Busch Olivier R, Bonsing Bert A, Stommel Martijn W J, Besselink Marc G
Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Cancer Center Amsterdam, Amsterdam, the Netherlands.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf068.
Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay.
This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined.
Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05).
This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.
胃排空延迟是胰十二指肠切除术后住院时间延长的主要原因。尽管术后加速康复指南建议胰十二指肠切除术后可自由进食，但评估术后不同喂养策略对胃排空延迟和住院时间影响的全国性研究有限。本研究旨在确定胰十二指肠切除术后不同喂养策略对胃排空延迟和住院时间的应用情况及影响。
这项全国性队列研究纳入了荷兰胰腺癌审计（2021 - 2023年）中胰十二指肠切除术后的连续患者。主要终点是胃排空延迟B/C级和住院时间。根据对15个中心代表的结构化访谈对喂养策略进行分类。采用多水平分析评估喂养策略、胃排空延迟和住院时间之间的关联。确定胃排空延迟的预测因素。
总体而言，纳入了2354例行胰十二指肠切除术的患者，其中526例（23%）发生胃排空延迟B/C级。胃排空延迟患者的中位住院时间长13天（23天对10天；P < 0.001）。喂养策略包括：自由进食（3个中心，637例患者；胃排空延迟18%）；逐步增加进食（9个中心，1462例患者；胃排空延迟24%）；以及人工喂养（3个中心，255例患者；胃排空延迟25%）。未观察到喂养策略与胃排空延迟之间的关联：逐步增加进食与自由进食相比（比值比1.14，95%置信区间0.53至2.47）以及人工喂养与自由进食相比（比值比1.76，0.65至4.73）。同样地，未发现喂养策略与住院时间之间的关联。胃排空延迟的最强预测因素是术后胰瘘（比值比3.16，2.47至4.05）。
本研究发现喂养策略与胰十二指肠切除术后胃排空延迟发生率或住院时间之间无显著关联。减少胃排空延迟的努力应集中在降低术后胰瘘的发生率上。
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