Post-operative nutrition in patients undergoing pancreaticoduodenectomy
Purpose: Pancreaticoduodenectomy is the standard surgical treatment for resectable periampullary and pancreatic head malignancies as well as some benign conditions confi ned to the pancreatic head. Peri-operative nutrition is a well-recognized aspect of care. Pre-operative nutrition status in pancreaticoduodenectomy patients has been recognized as a signifi cant variable aff ecting post-operative morbidity and mortality. In other upper gastrointestinal tract surgeries including esophagectomies and esophagogastrectomies, placing a jejnostomy tube at the time of surgery for nutritional support post-operatively is the standard practice and that has always been supported by the literature. Data extrapolated from the above dictated the routine use of jejunostomy tubes in pancreaticoduodenectomies as well. It is true though that pancreaticoduodenectomy is a discrete category. Although jejunostomy tube placement was the routine practice for patients undergoing pancreaticoduodenectomy, that or other nutrition modalities have always been controversial. Methods: We identifi ed relevant published research articles by a systematic review of PubMed Central electronic database conducted in August 2012. Search was run for the combination of "pancreaticoduodenectomy", "post-operative nutrition", "jejunostomy tube feeding", "total parenteral nutrition" using both standardized search terms and free text terms, including synonyms and alternative spellings. Conclusion: Jejunostomy tube feedings have been widely studied in patients undergoing pancreaticoduodenectomy and current studies performed do not support them over other nutrition modalities, as total parenteral or early by mouth nutrition. Recently, there is a shift towards reserving jejunostomy tube placement for patients with multiple comorbidities and severe complications. Early po intake has been studied and justifi ed as an appropriate post-operative nutrition and should be recommended after pancreaticoduodenectomy.