title: Effect of early enteral combined with parenteral nutrition in patients undergoing pancreaticoduodenectomy.
abstract: OBJECTIVE
  To investigate the effect of early enteral nutrition (EEN) combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy (PD).
  
  
  METHODS
  From January 2006, all patients were given EEN combined with parenteral nutrition (PN) (EEN/PN group, n = 107), while patients prior to this date were given total parenteral nutrition (TPN) (TPN group, n = 67). Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery. The assessment of clinical outcome was based on postoperative complications. Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge. Readmission within 30 d after discharge was also recorded.
  
  
  RESULTS
  Compared with the TPN group, a significant decrease in prealbumin (PAB) (P = 0.023) was seen in the EEN/PN group. Total bilirubin (TB), direct bilirubin (DB) and lactate dehydrogenase (LDH) were significantly decreased on day 6 in the EEN/PN group (P = 0.006, 0.004 and 0.032, respectively). The rate of grade I complications, grade II complications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased (P = 0.036, 0.028 and 0.021, respectively), and no hospital mortality was observed in our study. Compared with the TPN group (58.2%), the rate of infectious complications in the EEN/PN group (39.3%) was significantly decreased (P = 0.042). Eleven cases of delayed gastric emptying were noted in the TPN group, and 6 cases in the EEN/PN group. The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group (P = 0.031 and P = 0.040, respectively).
  
  
  CONCLUSIONS
  Early enteral combined with PN can greatly improve liver function, reduce infectious complications and delayed gastric emptying, and shorten postoperative hospital stay in patients undergoing PD.
authors.affiliation: Xin-Hua Zhu, Ya-Fu Wu, Yu-Dong Qiu, Chun-Ping Jiang, Yi-Tao Ding, Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China.
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Zhu
authors.forename: Ya-Fu
authors.initials: YF
authors.lastname: Wu
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Qiu
authors.forename: Chun-Ping
authors.initials: CP
authors.lastname: Jiang
authors.forename: Yi-Tao
authors.initials: YT
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D003141:Communicable Diseases / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D018589:Gastroparesis / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007902:Length of Stay; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010288:Parenteral Nutrition; D010359:Patient Readmission; D011228:Prealbumin / Q000378:metabolism; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D007770:L-Lactate Dehydrogenase; D001663:Bilirubin
keywords: Complications; Enteral nutrition; Metabolism; Pancreaticoduodenectomy; Parenteral nutrition