Skip to main content

Advertisement

SpringerLink
Log in

Influence of Food Intake on the Healing Process of Postoperative Pancreatic Fistula After Pancreatoduodenectomy: A Multi-institutional Randomized Controlled Trial

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The usefulness of enteral nutrition via a nasointestinal tube for patients who develop postoperative pancreatic fistula (POPF) after miscellaneous pancreatectomy procedures has been reported. However, no clear evidence regarding whether oral intake is possible during management of POPF after pancreatoduodenectomy (PD) is currently available. We investigated the effects of oral food intake on the healing process of POPF after PD by a multi-institutional randomized controlled trial.

Methods

Patients who developed POPF were randomly assigned to the dietary intake (DI) group (n = 30) or the fasted group [no dietary intake (NDI) group] (n = 29). The primary endpoint was the length of drain placement.

Results

No significant differences were found in the length of drain placement between the DI and NDI groups [27 (7–80) vs. 26 (7–70) days, respectively; p = .8858]. POPF progressed to a clinically relevant status (grade B/C) in 20 patients in the DI group and 19 patients in the NDI group (p = .9257). POPF-related intra-abdominal hemorrhage was found in 2 patients in the NDI group, but in no patients in the DI group (p = .1434). There were no significant differences in POPF-related intra-abdominal hemorrhage, the incidence of other complications, or the length of the postoperative hospital stay between the 2 groups.

Conclusion

Food intake did not aggravate POPF and did not prolong the length of drain placement or hospital stay after PD. There may be no need to avoid oral dietary intake in patients with POPF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gullo L, Priori P, Pezzilli R, Biliotti G, Mattioli G, Barbara L. Pancreatic secretory response to ordinary meals: studies with pure pancreatic juice. Gastroenterology. 1988;94:428–33.

    CAS  PubMed  Google Scholar 

  2. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  3. Fan BG. Effects of parenteral nutrition on the exocrine pancreas in response to cholecystokinin. JPEN J Parenter Enteral Nutr. 2008;32:57–62.

    Article  PubMed  Google Scholar 

  4. Klek S, Sierzega M, Turczynowski L, Szybinski P, Szczepanek K, Kulig J. Enteral and parenteral nutrition in the conservative treatment of pancreatic fistula: a randomized clinical trial. Gastroenterology. 2011;141:157–63.

    Article  PubMed  Google Scholar 

  5. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014;20:8505–24.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Zeki S, Culkin A, Gabe SM, Nightingale JM. Refeeding hypophosphataemia is more common in enteral than parenteral feeding in adult in patients. Clin Nutr. 2011;30:365–8.

    Article  CAS  PubMed  Google Scholar 

  7. Cowl CT, Weinstock JV, Al-Jurf A, Ephgrave K, Murray JA, Dillon K. Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters. Clin Nutr. 2000;19:237–43.

    Article  CAS  PubMed  Google Scholar 

  8. Fujii T, Kanda M, Kodera Y, Suenaga M, Yamamura K, Kodera Y. Preservation of the pyloric ring has little value in surgery for pancreatic head cancer: a comparative study comparing three surgical procedures. Ann Surg Oncol. 2012;19:176–83.

    Article  PubMed  Google Scholar 

  9. Nakao A, Kanzaki A, Fujii T, et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg. 2012;255:103–8.

    Article  PubMed  Google Scholar 

  10. Yamada S, Fujii T, Sugimoto H, Nomoto S, Takeda S, Kodera Y, Nakao A. Aggressive surgery for borderline resectable pancreatic cancer: evaluation of National Comprehensive Cancer Network guidelines. Pancreas. 2013;42:1004–10.

    Article  PubMed  Google Scholar 

  11. Fujii T, Sugimoto H, Yamada S, et al. Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg. 2014;18:1108–15.

    Article  PubMed  Google Scholar 

  12. Kakita A, Yoshida M, Takahashi T. History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique. J Hepatobiliary Pancreat Surg. 2001;8:230–7.

    Article  CAS  PubMed  Google Scholar 

  13. Nagai S, Fujii T, Kodera Y, et al. Impact of operative blood loss on survival in invasive ductal adenocarcinoma of the pancreas. Pancreas. 2011;40:3–9.

    Article  PubMed  Google Scholar 

  14. Fujii T, Kanda M, Kodera Y, et al. Comparison of pancreatic head resection with segmental duodenectomy and pylorus-preserving pancreatoduodenectomy for benign and low-grade malignant neoplasms of the pancreatic head. Pancreas. 2011;40:1258–63.

    Article  PubMed  Google Scholar 

  15. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5.

    Article  PubMed  Google Scholar 

  16. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.

    Article  PubMed  Google Scholar 

  17. Nagai S, Fujii T, Kodera Y, et al. Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol. 2011;18:2329–37.

    Article  PubMed  Google Scholar 

  18. Shinchi H, Takao S, Maenohara S, Aikou T. Gastric acidity following pancreaticogastrostomy with pylorus-preserving pancreaticoduodenectomy. World J Surg. 2000;24:86–90.

    Article  CAS  PubMed  Google Scholar 

  19. Sudo T, Ishiyama K, Kawamura M, et al. Changes in plasma gastrin and secretin levels after pancreaticoduodenectomy. Surg Gynecol Obstet. 1984;158:133–6.

    CAS  PubMed  Google Scholar 

  20. Ogasahara K, Suzuki T, Tobe T. Plasma secretin levels in total pancreatectomy and pancreaticoduodenectomy. Jpn J Surg. 1981;11:433–9.

    Article  CAS  PubMed  Google Scholar 

  21. Inoue K, Tobe T, Suzuki T, et al. Plasma cholecystokinin and pancreatic polypeptide response after radical pancreatoduodenectomy with Billroth I and Billroth II type of reconstruction. Ann Surg. 1987;206:148–54.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Morisset J. Negative control of human pancreatic secretion: physiological mechanisms and factors. Pancreas. 2008;37:1–12.

    Article  CAS  PubMed  Google Scholar 

  23. O’Keefe SJ. Physiological response of the human pancreas to enteral and parenteral feeding. Curr Opin Clin Nutr Metab Care. 2006;9:622–8.

    Article  PubMed  Google Scholar 

  24. Alves CC, Torrinhas RS, Giorgi R, Brentani MM, Logullo AF, Waitzberg DL. TGF-β1 expression in wound healing is acutely affected by experimental malnutrition and early enteral feeding. Int Wound J. 2014;11:533–9.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan

    Tsutomu Fujii MD, PhD, FACS, Akimasa Nakao MD, PhD, FACS, Yukiyasu Okamura MD, PhD, Suguru Yamada MD, PhD, FACS, Mitsuro Kanda MD, PhD, Hiroyuki Sugimoto MD, PhD, Shuji Nomoto MD, PhD, Shin Takeda MD, PhD & Yasuhiro Kodera MD, PhD, FACS

  2. Department of Surgery, Nagoya Central Hospital, Nagoya, Japan

    Akimasa Nakao MD, PhD, FACS

  3. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan

    Kenta Murotani PhD

  4. Department of Surgery, Konan Kosei Hospital, Konan, Japan

    Kiyoshi Ishigure MD, PhD

  5. Department of Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

    Tsuyoshi Hatsuno MD, PhD

  6. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan

    Mitsuru Sakai MD, PhD

  7. Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Satoshi Morita PhD

Authors
  1. Tsutomu Fujii MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akimasa Nakao MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenta Murotani PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukiyasu Okamura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kiyoshi Ishigure MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tsuyoshi Hatsuno MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mitsuru Sakai MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Suguru Yamada MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mitsuro Kanda MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroyuki Sugimoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shuji Nomoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shin Takeda MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Satoshi Morita PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yasuhiro Kodera MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsutomu Fujii MD, PhD, FACS.

Electronic supplementary material

Below is the link to the electronic supplementary material.

CONSORT diagram for the present trial (TIFF 58135 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujii, T., Nakao, A., Murotani, K. et al. Influence of Food Intake on the Healing Process of Postoperative Pancreatic Fistula After Pancreatoduodenectomy: A Multi-institutional Randomized Controlled Trial. Ann Surg Oncol 22, 3905–3912 (2015). https://doi.org/10.1245/s10434-015-4496-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4496-1

Keywords

Search

Navigation