Early enteral nutrition combined with supplemental parenteral nutrition versus total parenteral nutrition after pancreaticoduodenectomy: a retrospective and propensity score-matched analysis of postoperative complications

Jialing Li^1,2*Defu Hu²Jianjie Sheng²Zhiang Wang²Hexing Hang^3,4Yudong Qiu^2,3Dayu Chen^5*旭 伏^3*

• ¹Nanjing Drum Tower Hospital, Nanjing, China
• ²Department of Pancreatic and metabolic surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China, Department of Pancreatic and metabolic surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China, China
• ³Department of Pancreatic and metabolic surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China., Department of Pancreatic and metabolic surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China., China
• ⁴Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Liaoning Province, China
• ⁵Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China

Background: Postoperative nutritional support strategy after pancreaticoduodenectomy (PD) remains controversial. This retrospective study aims to evaluate early enteral nutrition (EEN) combined with supplemental parenteral nutrition (SPN) and parenteral nutrition (PN) as postoperative nutrition support on early clinical outcomes and postoperative complications in patients who underwent PD. Methods: Clinical data from consecutive patients who underwent PD between January 2022 and July 2024 were collected and analyzed in this retrospective study. The primary outcome was the incidence of postoperative complications. The secondary outcomes encompassed a comparison of postoperative complications between the two groups, including delayed gastric emptying (DGE), bile leak (BL), chyle leak (CL), acute pancreatitis (AP), postpancreatectomy hemorrhage (PPH), and infectious complications. A propensity score-matched (PSM) analysis was performed to balance baseline confounders between the two groups. Results: According to perioperative nutritional protocols, 248 patients were finally included and divided into EEN+SPN group (n=116) and PN group (n=132). After PSM, baseline characteristics were balanced between the EEN+SPN group (n=59) and PN group (n=59). No statistically significant differences were observed in the incidence of complications between the two groups, either before or after PSM (all P>0.05). Befor PSM, the overall incidence of severe postoperative complications was 10.1%. The EEN+SPN group demonstrated a significantly lower incidence of severe complications compared to the PN group both before and after PSM (P<0.05). Analysis of secondary outcomes (which included a comparative analysis of detailed complications) revealed no significant differences between the groups. Conclusion: In conclusion, this study demonstrates that for patients at nutritional risk following PD, EEN+SPN is a safe and feasible nutritional support strategy and is associated with a significant reduction in the incidence of severe complications.