Mesh meta-analysis of different enteral nutrition timing in patients with pancrea-ticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Xiaoyan ^1,2 , CHAI Changpeng ² , ZHANG Youdi ^1,2 ,  ZHOU Wence ^1,2

1. School of Nursing of Lanzhou University, Lanzhou 730000, P. R. China;
2. The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

ZHOU Wence, Email: zhouwc@lzu.edu.cn

Keywords：

nutritional support; pancreaticoduodenectomy; reticular meta-analysis

DOI：

10.7507/1007-9424.201906020

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Objective To systematically evaluate the effect of different enteral nutrition timing on patients with pancreaticoduodenectomy.Methods PubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP databases were searched to collect RCTs for nutritional support in pancreaticoduodenectomy patients. The search time was established until March 1 2019. After two independent investigators conducted literature screening, data extraction, and evaluation of the risk of bias in the included studies, a meta-metabolic analysis was performed using the R 3.5.3 software gemtc package, JAGS 3.4.0, and Revman software.Results A total of 8 RCTs were included, for a total of 825 patients. The results of reticular meta-analysis showed that there was no significant difference in the duration of hospitalization for patients with pancreaticoduodenectomy, between the enteral nutrition supported at different timing. The results of the ranking probability map suggested that preoperative enteral nutrition was a better option for supporting nutrition in patients with pancreaticoduodenectomy, secondly, timing to give was 24–48 hours after operation.Conclusions According to the results of mesh meta-analysis and probabilistic ranking, the nutritional status of patients is corrected before surgery, and the effect of enteral nutrition is better than other nutritional support methods. Secondly, enteral nutrition should be given at 24–48 hours after operation in combination with ESPEN and ERAS recommendations.

Citation： LIU Xiaoyan, CHAI Changpeng, ZHANG Youdi, ZHOU Wence. Mesh meta-analysis of different enteral nutrition timing in patients with pancrea-ticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1452-1460. doi: 10.7507/1007-9424.201906020 Copy

1.	Gerritsen A, Besselink MG, Gouma DJ, et al. Systematic review of five feeding routes after pancreatoduodenectomy. Br J Surg, 2013, 100(5): 589-598.
2.	Buscemi S, Damiano G, Palumbo VD, et al. Enteral nutrition in pancreaticoduodenectomy: a literature review. Nutrients, 2015, 7(5): 3154-3165.
3.	Tan WJ, Kow AW, Liau KH. Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new. HPB (Oxford), 2011, 13(8): 566-572.
4.	Welsch T, Borm M, Degrate L, et al. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg, 2010, 97(7): 1043-1050.
5.	Guilbaud T, Birnbaum DJ, Loubière S, et al. Comparison of different feeding regimes after pancreatoduodenectomy—a retrospective cohort analysis. Nutr J, 2017, 16(1): 42.
6.	Correia MI, Caiaffa WT, da Silva AL, et al. Risk factors for malnutrition in patients undergoing gastroenterological and hernia surgery: an analysis of 374 patients. Nutr Hosp, 2001, 16(2): 59-64.
7.	Kimura F, Shimizu H, Yoshidome H, et al. Increased plasma levels of IL-6 and IL-8 are associated with surgical site infection after pancreaticoduodenectomy. Pancreas, 2006, 32(2): 178-185.
8.	Su Z, Koga R, Saiura A, et al. Factors influencing infectious complications after pancreatoduodenectomy. J Hepatobiliary Pancreat Sci, 2010, 17(2): 174-179.
9.	Schiesser M, Kirchhoff P, Muller MK, et al. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery, 2009, 145(5): 519-526.
10.	Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr, 2003, 22(3): 235-239.
11.	Schnelldorfer T, Adams DB. The effect of malnutrition on morbidity after surgery for chronic pancreatitis. Am Surg, 2005, 71(6): 466-472.
12.	Gilliland TM, Villafane-Ferriol N, Shah KP, et al. Nutritional and metabolic derangements in pancreatic cancer and pancreatic resection. Nutrients, 2017, 9(3): pii: E243.
13.	张超, 董圣杰, 曾宪涛, 等. R 软件 gemtc 程序包在网状 Meta 分析中的应用. 中国循证医学杂志, 2013, 13(10): 1258-1264.
14.	张超, 孙凤, 曾宪涛. R 软件调用 JAGS 软件实现网状 Meta 分析. 中国循证医学杂志, 2014, 14(02): 241-248.
15.	张超, 鄢金柱, 孙凤, 等. 网状 Meta 分析一致性的鉴别与处理方法. 中国循证医学杂志, 2014, 14(7): 884-888.
16.	徐军辉, 丁佑铭, 汪斌. 术前营养支持对存在营养风险患者胰十二指肠切除术后临床结局的影响. 中华胰腺病杂志, 2015, 15(4): 225-228.
17.	陈耀智. 胰十二指肠切除术后肠内营养支持的效果观察. 中国医药指南, 2012, 10(35): 558-559.
18.	杨延辉, 赵白皖, 李园, 等. 胰十二指肠切除术后早期经口肠内营养安全性和可行性的临床研究. 肠外与肠内营养, 2011, 18(1): 24-27.
19.	温冰, 娄礼广. 围手术期营养支持在胰十二指肠切除术病人的临床应用. 肠外与肠内营养, 2007, 14(4): 219-222, 225.
20.	郭俊超, 李建, 胡亚, 等. 胰腺癌围手术期肠内外营养支持治疗的多中心、前瞻性随机对照研究. 中华外科杂志, 2013, 51(11): 987-990.
21.	Gianotti L, Braga M, Vignali A, et al. Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasms. Arch Surg, 1997, 132(11): 1222-1229.
22.	Gianotti L, Braga M, Gentilini O, et al. Artificial nutrition after pancreaticoduodenectomy. Pancreas, 2000, 21(4): 344-351.
23.	Park JS, Chung HK, Hwang HK, et al. Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in pancreaticoduodectomy patients: a prosepective, randomized study. J korean Med Sci, 2012, 27(3): 261-267.
24.	Perinel J, Mariette C, Dousset B, et al. Early enteral versus total parenteral nutrition in patients undergoing pancrea-ticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC). Ann Surg, 2016, 264(5): 731-737.
25.	Probst P, Keller D, Steimer J, et al. Early combined parenteral and enteral nutrition for pancreaticoduodenectomy—retrospective cohort analysis. Ann Med Surg (Lond), 2016, 6: 68-73.
26.	谈善军, 虞文魁, 林志亮, 等. 早期肠内营养对胰十二指肠切除术后病人预后影响的 Meta 分析. 肠外与肠内营养, 2016, 23(1): 12-17, 20.
27.	Lee SH, Lee JG. Early enteral nutrition still has advantages in patients undergoing pancreaticoduodenectomy. J Thorac Dis, 2016, 8(10): 1340-1342.
28.	汪志明, 李宁. 肠道微生态与营养支持. 中国实用外科杂志, 2012, 32(2): 167-169.
29.	Habschmidt MG, Bacon CA, Gregoire MB, et al. Medical nutrition therapy provided to adult hematopoietic stem cell transplantation patients. Nutr Clin Pract, 2012, 27(5): 655-660.
30.	李智德, 简志祥, 周雨, 等. 老年患者胰十二指肠切除术后早期肠内营养的应用价值. 胃肠病学和肝病学杂志, 2016, 25(6): 691-694.
31.	Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg, 2008, 12(4): 739-755.
32.	Zhu XH, Wu Y F, Qiu Y D, et al. Effect of early enteral combined with parenteral nutrition in patients undergoing panc-reaticoduodenectomy. World J Gastroenterol, 2013, 19(35): 5889-5896.
33.	Weimann A, Braga M, Harsanyi L, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr, 2006, 25(2): 224-244.
34.	ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr, 2002, 26(1 Suppl): 131SA-138SA.
35.	La Torre M, Ziparo V, Nigri G, et al. Malnutrition and pancreatic surgery: prevalence and outcomes. J Surg Oncol, 2013, 107(7): 702-708.
36.	Miyauchi Y, Furukawa K, Suzuki D, et al. Additional effect of perioperative, compared with preoperative, immunonutrition after pancreaticoduodenectomy: A randomized, controlled trial. Int J Surg, 2018, 61: 69-75.
37.	Bozzetti F, Mariani L. Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition, 2014, 30(11-12): 1267-1271.

1. Gerritsen A, Besselink MG, Gouma DJ, et al. Systematic review of five feeding routes after pancreatoduodenectomy. Br J Surg, 2013, 100(5): 589-598.
2. Buscemi S, Damiano G, Palumbo VD, et al. Enteral nutrition in pancreaticoduodenectomy: a literature review. Nutrients, 2015, 7(5): 3154-3165.
3. Tan WJ, Kow AW, Liau KH. Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new. HPB (Oxford), 2011, 13(8): 566-572.
4. Welsch T, Borm M, Degrate L, et al. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg, 2010, 97(7): 1043-1050.
5. Guilbaud T, Birnbaum DJ, Loubière S, et al. Comparison of different feeding regimes after pancreatoduodenectomy—a retrospective cohort analysis. Nutr J, 2017, 16(1): 42.
6. Correia MI, Caiaffa WT, da Silva AL, et al. Risk factors for malnutrition in patients undergoing gastroenterological and hernia surgery: an analysis of 374 patients. Nutr Hosp, 2001, 16(2): 59-64.
7. Kimura F, Shimizu H, Yoshidome H, et al. Increased plasma levels of IL-6 and IL-8 are associated with surgical site infection after pancreaticoduodenectomy. Pancreas, 2006, 32(2): 178-185.
8. Su Z, Koga R, Saiura A, et al. Factors influencing infectious complications after pancreatoduodenectomy. J Hepatobiliary Pancreat Sci, 2010, 17(2): 174-179.
9. Schiesser M, Kirchhoff P, Muller MK, et al. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery, 2009, 145(5): 519-526.
10. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr, 2003, 22(3): 235-239.
11. Schnelldorfer T, Adams DB. The effect of malnutrition on morbidity after surgery for chronic pancreatitis. Am Surg, 2005, 71(6): 466-472.
12. Gilliland TM, Villafane-Ferriol N, Shah KP, et al. Nutritional and metabolic derangements in pancreatic cancer and pancreatic resection. Nutrients, 2017, 9(3): pii: E243.
13. 张超, 董圣杰, 曾宪涛, 等. R 软件 gemtc 程序包在网状 Meta 分析中的应用. 中国循证医学杂志, 2013, 13(10): 1258-1264.
14. 张超, 孙凤, 曾宪涛. R 软件调用 JAGS 软件实现网状 Meta 分析. 中国循证医学杂志, 2014, 14(02): 241-248.
15. 张超, 鄢金柱, 孙凤, 等. 网状 Meta 分析一致性的鉴别与处理方法. 中国循证医学杂志, 2014, 14(7): 884-888.
16. 徐军辉, 丁佑铭, 汪斌. 术前营养支持对存在营养风险患者胰十二指肠切除术后临床结局的影响. 中华胰腺病杂志, 2015, 15(4): 225-228.
17. 陈耀智. 胰十二指肠切除术后肠内营养支持的效果观察. 中国医药指南, 2012, 10(35): 558-559.
18. 杨延辉, 赵白皖, 李园, 等. 胰十二指肠切除术后早期经口肠内营养安全性和可行性的临床研究. 肠外与肠内营养, 2011, 18(1): 24-27.
19. 温冰, 娄礼广. 围手术期营养支持在胰十二指肠切除术病人的临床应用. 肠外与肠内营养, 2007, 14(4): 219-222, 225.
20. 郭俊超, 李建, 胡亚, 等. 胰腺癌围手术期肠内外营养支持治疗的多中心、前瞻性随机对照研究. 中华外科杂志, 2013, 51(11): 987-990.
21. Gianotti L, Braga M, Vignali A, et al. Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasms. Arch Surg, 1997, 132(11): 1222-1229.
22. Gianotti L, Braga M, Gentilini O, et al. Artificial nutrition after pancreaticoduodenectomy. Pancreas, 2000, 21(4): 344-351.
23. Park JS, Chung HK, Hwang HK, et al. Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in pancreaticoduodectomy patients: a prosepective, randomized study. J korean Med Sci, 2012, 27(3): 261-267.
24. Perinel J, Mariette C, Dousset B, et al. Early enteral versus total parenteral nutrition in patients undergoing pancrea-ticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC). Ann Surg, 2016, 264(5): 731-737.
25. Probst P, Keller D, Steimer J, et al. Early combined parenteral and enteral nutrition for pancreaticoduodenectomy—retrospective cohort analysis. Ann Med Surg (Lond), 2016, 6: 68-73.
26. 谈善军, 虞文魁, 林志亮, 等. 早期肠内营养对胰十二指肠切除术后病人预后影响的 Meta 分析. 肠外与肠内营养, 2016, 23(1): 12-17, 20.
27. Lee SH, Lee JG. Early enteral nutrition still has advantages in patients undergoing pancreaticoduodenectomy. J Thorac Dis, 2016, 8(10): 1340-1342.
28. 汪志明, 李宁. 肠道微生态与营养支持. 中国实用外科杂志, 2012, 32(2): 167-169.
29. Habschmidt MG, Bacon CA, Gregoire MB, et al. Medical nutrition therapy provided to adult hematopoietic stem cell transplantation patients. Nutr Clin Pract, 2012, 27(5): 655-660.
30. 李智德, 简志祥, 周雨, 等. 老年患者胰十二指肠切除术后早期肠内营养的应用价值. 胃肠病学和肝病学杂志, 2016, 25(6): 691-694.
31. Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg, 2008, 12(4): 739-755.
32. Zhu XH, Wu Y F, Qiu Y D, et al. Effect of early enteral combined with parenteral nutrition in patients undergoing panc-reaticoduodenectomy. World J Gastroenterol, 2013, 19(35): 5889-5896.
33. Weimann A, Braga M, Harsanyi L, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr, 2006, 25(2): 224-244.
34. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr, 2002, 26(1 Suppl): 131SA-138SA.
35. La Torre M, Ziparo V, Nigri G, et al. Malnutrition and pancreatic surgery: prevalence and outcomes. J Surg Oncol, 2013, 107(7): 702-708.
36. Miyauchi Y, Furukawa K, Suzuki D, et al. Additional effect of perioperative, compared with preoperative, immunonutrition after pancreaticoduodenectomy: A randomized, controlled trial. Int J Surg, 2018, 61: 69-75.
37. Bozzetti F, Mariani L. Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition, 2014, 30(11-12): 1267-1271.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Mesh meta-analysis of different enteral nutrition timing in patients with pancrea-ticoduodenectomy

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