title: Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center.
abstract: OBJECTIVE
  To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN).
  
  
  METHODS
  Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed.
  
  
  RESULTS
  The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.
  
  
  CONCLUSIONS
  Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.
authors.affiliation: Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Jian-Wen
authors.initials: JW
authors.lastname: Lu
authors.affiliation: Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.affiliation: Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Zhao-Qing
authors.initials: ZQ
authors.lastname: Du
authors.affiliation: Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Xue-Min
authors.initials: XM
authors.lastname: Liu
authors.affiliation: Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lv
authors.affiliation: Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Xu-Feng
authors.initials: XF
authors.lastname: Zhang
mesh_terms: D002681:China; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Delayed gastric emptying; Enteral nutrition; Pancreaticoduodenectomy; Parenteral nutrition; Postoperative complications