Pylorus Resecting Pancreatoduodenectomy With or Without Feeding Jejunostomy-A Randomized Controlled Trial

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Nutrition

Background:

• Postoperative nutrition following pancreatoduodenectomy (PD) is debated.
• Feeding jejunostomy tube (FJT) placement is common but linked to morbidity.
• This study compares perioperative outcomes with and without FJT post-PD.

Purpose of the Study:

• To compare perioperative outcomes between FJT and nasojejunal tube (NJT) placement after PD.
• To evaluate the impact of FJT on clinically relevant delayed gastric emptying (CR-DGE).
• To assess secondary outcomes including postoperative pancreatic fistula, complications, and hospital stay.

Main Methods:

• Open-label randomized controlled trial comparing FJT versus NJT.
• Included patients with periampullary neoplasm undergoing PD with pylorus resection.
• Primary outcome: CR-DGE; Secondary outcomes: CR-POPF, complications, hospital stay.

Main Results:

• Forty patients were randomized; groups were comparable in demographics and CR-POPF rates.
• FJT group showed significantly higher CR-DGE (55% vs. 25%), increased prokinetic drug use, and longer hospital stay (11 vs. 9 days).
• FJT was an independent risk factor for CR-DGE (aOR, 6.030).

Conclusions:

• Routine FJT placement after PD is an independent risk factor for CR-DGE.
• Omission of FJT after PD is feasible without compromising postoperative morbidity or nutrition.
• NJT can be a suitable alternative for postoperative feeding in PD patients.