Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy.

BACKGROUND Although nutritional supplementation is established in surgical practice, studies on feeding patients undergoing pancreaticoduodenectomy utilise widely disparate protocols, include small numbers of patients and have disparate endpoints. The aim of this study is to carry out a systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy in order to identify consistent themes. METHODS Searches of the MEDLINE and EMBASE databases yielded 10 studies examining nutritional support in 571 patients undergoing pancreaticoduodenectomy. Data were retrieved on: proportion of pre-operative weight loss, biochemical parameters (pre-operative albumin and the presence of jaundice), type and duration of nutritional support and clinical outcome (morbidity, mortality and hospital stay). RESULTS Pre-operative percentage weight loss was similar in all studies evaluated. Routine post-operative total parenteral nutrition (TPN) was associated with a higher incidence of complications. Enteral nutrition reduced infective complications. Cyclical nutrition was associated with a lower incidence of post-operative gastric stasis. CONCLUSION Clear themes emerge from this systematic review. Patients undergoing pancreaticoduodenectomy are nutritionally depleted at the time of surgery and the pre-operative period may present a window for intervention. Routine TPN is not beneficial. Routine post-operative enteral nutritional support, delivered on a cyclical basis appears to be the optimal mode of delivery.