Early enteral nutrition after pancreatoduodenectomy: a meta-analysis of randomized controlled trials

The aim of our study was to evaluate the safety and effectiveness of early enteral nutrition (EN) for patients after pancreatoduodenectomy (PD). We performed a comprehensive search of abstracts in the MEDLINE database, OVID database, Springer database, the Science Citation Index, and the Cochrane Library database. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of early EN and other nutritional routes for patients after PD were analyzed. The analyzed outcome variables included gastroparesis, intra-abdominal complications (gastroparesis excluded), mortality, infection, and postoperative hospital stay. The Cochrane Collaboration's RevMan 5.1 software was used for statistical analysis. Four RCTs published in 2000 or later were included in this meta-analysis, in which 246 patients underwent early EN and 238 patients underwent other nutritional routes following PD. In the combined results of early EN versus other nutritional routes, no significant difference could be found in gastroparesis (odds ratio (OR), 0.89; 95 % CI, 0.36-2.18; P = 0.79), intra-abdominal complications (gastroparesis excluded) (OR, 0.82; 95 % CI, 0.53-1.26; P = 0.37), mortality (OR, 0.43; 95 % CI, 0.11-1.62; P = 0.21), infection (OR, 0.55; 95 % CI, 0.29-1.07; P = 0.08), postoperative hospital stay (mean difference, -0.93; 95 % CI, -6.51 to 4.65; P = 0.74). Current RCTs suggests that early EN appears safe and tolerated for patients after PD, but does not show advantages in infection and postoperative hospital stay.