Early oral feeding after pancreatoduodenectomy: a systematic review and meta-analysis. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Halle-Smith, James M.; Pande, Rupaly; Powell-Brett, Sarah; Pathak, Samir; Pandanaboyana, Sanjay; Smith, Andrew M.; Roberts, Keith J.
• Is Part Of: HPB. Volume 24:Issue 10(2022)
• Page Start: 1615
• Page End: 1621
• Publication Date: 2022-10
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2022.04.005
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: 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). Methods: 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). Results: 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). Conclusion: 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.