title: Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether a change in the routine feeding strategy applied after pancreatoduodenectomy (PD) from nasojejunal tube (NJT) feeding to early oral feeding improved clinical outcomes.
  
  
  METHODS
  An observational cohort study was performed in 102 consecutive patients undergoing PD. In period 1 (n = 51, historical controls), the routine postoperative feeding strategy was NJT feeding. This was changed to a protocol of early oral feeding with on-demand NJT feeding in period 2 (n = 51, consecutive prospective cohort). The primary outcome was time to resumption of adequate oral intake.
  
  
  RESULTS
  The baseline characteristics of study subjects in both periods were comparable. In period 1, 98% (n = 50) of patients received NJT feeding, whereas in period 2, 53% (n = 27) of patients did so [for delayed gastric empting (DGE) (n = 20) or preoperative malnutrition (n = 7)]. The time to resumption of adequate oral intake significantly decreased from 12 days in period 1 to 9 days in period 2 (P = 0.015), and the length of hospital stay shortened from 18 days in period 1 to 13 days in period 2 (P = 0.015). Overall, there were no differences in the incidences of complications of Clavien-Dindo Grade III or higher, DGE, pancreatic fistula, postoperative haemorrhage and mortality between the two periods.
  
  
  CONCLUSIONS
  The introduction of an early oral feeding strategy after PD reduced the time to resumption of adequate oral intake and length of hospital stay without negatively impacting postoperative morbidity.
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Arja
authors.initials: A
authors.lastname: Gerritsen
authors.forename: Roos A W
authors.initials: RA
authors.lastname: Wennink
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.forename: Dorine S J
authors.initials: DS
authors.lastname: Tseng
authors.forename: Elles
authors.initials: E
authors.lastname: Steenhagen
authors.forename: Inne H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004435:Eating; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome