Early Oral Intake After Pancreaticoduodenectomy in the Age of ERAS

Overview

Early oral intake after Pancreaticoduodenectomy is recommended strongly according to the ERAS guideline, which was based on studies in patients with gastrointestinal cancer, mainly colorectal and gastric. Specific clinical study on early oral intake after PD is very limited. inadequate nutritional intake was significantly associated with a high incidence of postoperative complications. Therefore, the present study is aim to evaluate the tolerance, safety, and efficacy in the patients undergoing PD in the age of ERAS.

Full Title of Study: “A Prospective, Randomized Trial of Early Oral Intake After Pancreaticoduodenectomy in the Age of ERAS”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Investigator)
  • Study Primary Completion Date: December 2019

Detailed Description

Enhanced Recovery After Surgery (ERAS) is an interdisciplinary, multimodal concept and has become an important focus of Pancreaticoduodenectomy procedures following universal accepted and practice in gastrointestinal and colorectal surgeries. Early oral diet without restrictions after operation is recommended strongly according to ERAS guideline. However, several studies demonstrated that only half validated the true practice of the postoperative oral diet. Furthermore, Oral intake tolerance after PD is controversial. Only 23% of patients were able to take solid food at day 3. It appears that adequate nutritional intake only via oral diet is a severe challenge. Besides, Studies showed that insufficient amount of dietary intake was significantly associated with extended duration of postoperative hospitalization and parenteral nutrition. Importantly, Specific clinical study on early oral intake after PD is very limited. Therefore, the present study is aim to evaluate the tolerance, safety, and efficacy in the patients undergoing PD in the age of ERAS.

Interventions

  • Procedure: early oral intake
    • early oral intake is started within 24 hours after pancreaticoduodenectomies following to the ERAS guideline
  • Procedure: jejunostomy tube feeding (JTF)
    • The jejunostomy tube was placed using the Flocare CH-10 tube with the longitudinal Witzel jejunostomy technique.nutrition is supplemented via JTF rather than early oral intake.Velocity is progressively increased by 20ml/hr until full nutritional goal (25Kcal/Kg)

Arms, Groups and Cohorts

  • Experimental: 1 early oral intake
    • early oral intake since postoperative day 1.
  • Experimental: 2 jejunostomy tube feeding (JTF)
    • jejunostomy tube feeding (JTF) was carried out after PD

Clinical Trial Outcome Measures

Primary Measures

  • Tolerance of Oral Intake
    • Time Frame: postoperative 1 to 7day
    • the amount of oral intake is recorded, including clear fluids, soft and solid food.

Secondary Measures

  • morbidity rate
    • Time Frame: postoperative 1day to discharge, up to 8 weeks
    • complications associated with surgery, early oral intake,and jejunostomy tube.Definitions used for specific complications are according to the International Study Group on Pancreatic Fistula (ISGPF) definition.
  • length of stay
    • Time Frame: postoperative 1day to discharge,up to 8 weeks
    • postoperative length of stay
  • Readmission rate
    • Time Frame: 30 days after discharge
  • Hospital costs
    • Time Frame: postoperative 1day to discharge,up to 8 weeks
  • Albumin
    • Time Frame: postoperative 30d
    • serum albumin
  • weight
    • Time Frame: postoperative 30d
    • weight in kilograms
  • height
    • Time Frame: postoperative 30d
    • height in meters

Participating in This Clinical Trial

Inclusion Criteria

  • Periampullar carcinoma – Pancreaticoduodenectomy – ERAS protocol implemented Exclusion Criteria:

  • Preoperative Radiotherapy/chemotherapy – Unresectable primary cancer – Palliative surgery – New York Heart Association class>3

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Xuzhou Medical University
  • Collaborator
    • The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
  • Provider of Information About this Clinical Study
    • Principal Investigator: Zheng Chen, the director of general surgery; – Xuzhou Medical University
  • Overall Official(s)
    • zheng chen, MD;PHD, Principal Investigator, Suqian Hospital
  • Overall Contact(s)
    • zheng chen, MD;PHD, 86-13809092636, zhengchenseu@126.com

References

Bozzetti F, Mariani L. Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition. 2014 Nov-Dec;30(11-12):1267-71. doi: 10.1016/j.nut.2014.03.002. Epub 2014 Mar 14.

Buscemi S, Damiano G, Palumbo VD, Spinelli G, Ficarella S, Lo Monte G, Marrazzo A, Lo Monte AI. Enteral nutrition in pancreaticoduodenectomy: a literature review. Nutrients. 2015 Apr 30;7(5):3154-65. doi: 10.3390/nu7053154.

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003 Jun;22(3):321-36. doi: 10.1016/s0261-5614(02)00214-5.

Afaneh C, Gerszberg D, Slattery E, Seres DS, Chabot JA, Kluger MD. Pancreatic cancer surgery and nutrition management: a review of the current literature. Hepatobiliary Surg Nutr. 2015 Feb;4(1):59-71. doi: 10.3978/j.issn.2304-3881.2014.08.07.

Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schafer M, Parks RW, Fearon KC, Lobo DN, Demartines N, Braga M, Ljungqvist O, Dejong CH; Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. World J Surg. 2013 Feb;37(2):240-58. doi: 10.1007/s00268-012-1771-1. No abstract available.

Nussbaum DP, Penne K, Stinnett SS, Speicher PJ, Cocieru A, Blazer DG 3rd, Zani S, Clary BM, Tyler DS, White RR. A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy. J Surg Res. 2015 Jan;193(1):237-45. doi: 10.1016/j.jss.2014.06.036. Epub 2014 Jun 26.

Wei J, Chen W, Zhu M, Cao W, Wang X, Shi H, Dong B, Sun J, Chen H, Zhou Y, Zhou S, Xu J; Chinese Medical Association's Nutrition Support Group for Geriatric Patients. Guidelines for parenteral and enteral nutrition support in geriatric patients in China. Asia Pac J Clin Nutr. 2015;24(2):336-46. doi: 10.6133/apjcn.2015.24.2.11.

Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P; DGEM (German Society for Nutritional Medicine); Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH; ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr. 2006 Apr;25(2):224-44. doi: 10.1016/j.clnu.2006.01.015. Epub 2006 May 15.

Bounoure L, Gomes F, Stanga Z, Keller U, Meier R, Ballmer P, Fehr R, Mueller B, Genton L, Bertrand PC, Norman K, Henzen C, Laviano A, Bischoff S, Schneider SM, Kondrup J, Schuetz P; Members of the Working Group. Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines. Nutrition. 2016 Jul-Aug;32(7-8):790-8. doi: 10.1016/j.nut.2016.01.019. Epub 2016 Feb 18.

Joliat GR, Labgaa I, Petermann D, Hubner M, Griesser AC, Demartines N, Schafer M. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br J Surg. 2015 Dec;102(13):1676-83. doi: 10.1002/bjs.9957. Epub 2015 Oct 22.

Coolsen MM, Bakens M, van Dam RM, Olde Damink SW, Dejong CH. Implementing an enhanced recovery program after pancreaticoduodenectomy in elderly patients: is it feasible? World J Surg. 2015 Jan;39(1):251-8. doi: 10.1007/s00268-014-2782-x.

Chaudhary A, Barreto SG, Talole SD, Singh A, Perwaiz A, Singh T. Early discharge after pancreatoduodenectomy: what helps and what prevents? Pancreas. 2015 Mar;44(2):273-8. doi: 10.1097/MPA.0000000000000254.

Bischoff SC, Singer P, Koller M, Barazzoni R, Cederholm T, van Gossum A. Standard operating procedures for ESPEN guidelines and consensus papers. Clin Nutr. 2015 Dec;34(6):1043-51. doi: 10.1016/j.clnu.2015.07.008. Epub 2015 Jul 16.

Braga M, Pecorelli N, Ariotti R, Capretti G, Greco M, Balzano G, Castoldi R, Beretta L. Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg. 2014 Nov;38(11):2960-6. doi: 10.1007/s00268-014-2653-5.

Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013 Aug;37(8):1909-18. doi: 10.1007/s00268-013-2044-3.

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