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2010 Annual Meeting Abstracts
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Effect of Early Enteral Tube Feeding on Patient Outcome Following Pancreaticoduodenectomy
*Georgios V. Georgakis1, *David P. Eisenberg2, Robert J. Piorkowski2, William P. Macaulay2, Ramon E Jimenez2
1University of Connecticut Medical School, Farmington, CT;2Hartford Hospital, Hartford, CT
Objective: Morbidity after pancreaticoduodenectomy (PD) averages nearly 50%. Many surgeons have recommended feeding tube (FT) placement at the time of surgery to maintain nutrition in the face of complications. In this study we analyzed if FT placement contributes to better patient outcomes after PD.
Design: Before-after trial. Consecutive patient series from 2003-2010. FT were placed routinely before August 2006, and omitted thereafter.
Setting: Large community teaching hospital
Patients: Prospectively maintained database of PD performed by 3 surgical oncologists. N=59. Median follow-up is 22 months.
Intervention: Placement of gastrojejunostomy FT and start of feeding by postoperative day 2-4.
Main Outcome Measures: Mortality, time to start of oral diet, need for TPN, pancreatic fistula, complications from FT, hospital length of stay, time to start adjuvant therapy, patient disposition, median survival.
Results: For all patients average age was 65, 51% were males, and perioperative mortality was 5%. Periampullary invasive adenocarcinoma was found in 81% of patients. Twenty-five patients had FT, and 34 did not. Early institution of tube feeding had no significant impact on any of our outcome measures (Table). There were 3 FT complications: 2 FT were nonfunctional (clogged), and 1 patient died from small bowel erosion and perforation.
Conclusions: Our results demonstrate that FT placement does not improve short-term or long-term outcomes after PD. Moreover, major complications can result from FT placement. We do not advocate the routine use of FT after PD, but recognize that it may be useful in very select cases.
Effect of Tube Feeding on Patient Outcomes After Pancreaticoduodenectomy | Feeding Tube | No Feeding Tube | P value | | N | 25 | 34 | NS | | Perioperative Mortality | 2 | 1 | NS | | Time to start of oral intake | 6 days | 5 days | NS | | Pancreatic fistula | 20% | 11% | NS | | Need for TPN | 16% | 21% | NS | | Length of stay | 14 days | 11 days | NS | | Disposition (Home) | 50% | 76% | NS | | Time to start of adjuvant therapy | 47 days | 46 days | NS | | Median Survival | 18 months | 18 months | NS |
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