title: Early Enteral Versus Total Parenteral Nutrition in Patients Undergoing Pancreaticoduodenectomy: A Randomized Multicenter Controlled Trial (Nutri-DPC).
abstract: OBJECTIVE
  The aim of this study was to compare nasojejunal early enteral nutrition (NJEEN) with total parenteral nutrition (TPN), after pancreaticoduodenectomy (PD), in terms of postoperative complications.
  
  
  BACKGROUND
  Current nutritional guidelines recommend the use of enteral over parenteral nutrition in patients undergoing gastrointestinal surgery. However, the NJEEN remains controversial in patients undergoing PD.
  
  
  METHODS
  Multicenter, randomized, controlled trial was conducted between 2011 and 2014. Nine centers in France analyzed 204 patients undergoing PD to NJEEN (n = 103) or TPN (n = 101). Primary outcome was the rate of postoperative complications according to Clavien-Dindo classification. Successful NJEEN was defined as insertion of a nasojejunal feeding tube, delivering at least 50% of nutritional needs on PoD 5, and no TPN for more than consecutive 48 hours.
  
  
  RESULTS
  Postoperative complications occurred in 77.5% [95% confidence interval (95% CI) 68.1-85.1] patients in the NJEEN group versus 64.4% (95% CI 54.2-73.6) in TPN group (P = 0.040). NJEEN was associated with higher frequency of postoperative pancreatic fistula (POPF) (48.1% vs 27.7%, P = 0.012) and higher severity (grade B/C 29.4% vs 13.9%; P = 0.007). There was no significant difference in the incidence of post-pancreatectomy hemorrhage, delayed gastric emptying, infectious complications, the grade of postoperative complications, and the length of postoperative stay. A successful NJEEN was achieved in 63% patients. In TPN group, average energy intake was significantly higher (P < 0.001) and patients had an earlier recovery of oral feeding (P = 0.0009).
  
  
  CONCLUSIONS
  In patients undergoing PD, NJEEN was associated with an increased overall postoperative complications rate. The frequency and the severity of POPF were also significantly increased after NJEEN. In terms of safety and feasibility, NJEEN should not be recommended.
authors.affiliation: *Department of Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, UCBL1, Lyon, France†Department of Digestive and General Surgery, Hôpital C. Huriez CHRU, Lille, France‡Department of Digestive Surgery, Hôpital Cochin - St-Vincent de Paul, Paris, France§Department of Digestive Surgery, CHU Timone, Marseille, France¶Department of Digestive Surgery, CHU Dupuytren, Limoges, France||Department of Digestive Surgery and Liver Transplantation, Hôpital de la Croix Rousse, Lyon, France**Pole Information Médicale Evaluation Recherche, HCL, Lyon, France††Department of Hepato-Biliary and Pancreatic Surgery, APHP, Hôpital Beaujon, Clichy, France‡‡Department of Digestive Surgery, APHP, Hôpital Lariboisières, Paris, France§§Department of Digestive Pathology, Surgery Unit, CHU Clermont Ferrand Hôtel Dieu NHE, Clermont Ferrand, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Perinel
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Igor
authors.initials: I
authors.lastname: Sielezneff
authors.forename: Alain
authors.initials: A
authors.lastname: Gainant
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bin-Dorel
authors.forename: Michel El
authors.initials: ME
authors.lastname: Bechwaty
authors.forename: Dominique
authors.initials: D
authors.lastname: Delaunay
authors.forename: Lorraine
authors.initials: L
authors.lastname: Bernard
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Buc
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
mesh_terms: D000368:Aged; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010289:Parenteral Nutrition, Total; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome