Short-term clinical outcomes of enteral nutrition versus parenteral nutrition after surgery for pancreatic cancer: a meta-analysis

BACKGROUND: The short-term clinical outcomes between early enteral nutrition (EEN) and total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD) for pancreatic cancer were not clear. METHODS: We searched the PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases to identify randomized controlled studies comparing EEN and TPN after PD for pancreatic cancer. Then a meta-analysis was conducted. RESULTS: Seven studies with 486 patients were included in the analysis. After surgery, patients in EEN group had higher level of plasma total protein (TP) [weighted mean difference (WMD): 1.83, 95% confidence interval (CI): 0.33–3.32, P=0.02], while the albumin (ALB) level was similar between the two groups (WMD: 0.25, 95% CI: –4.07–4.56, P=0.91). As for the bowel function, EEN group had shorter exhaust time (WMD: –0.66, 95% CI: –0.81 to –0.51, P<0.001) and bowel movement time (WMD: –2.27, 95% CI: –2.61 to –1.94, P<0.001) than TPN group. EEN group also had lower short-term total complication rate [relative risk (RR): 0.68, 95% CI: 0.51–0.92, P=0.01] and postoperative hemorrhage rate (RR: 0.22, 95% CI: 0.06–0.75, P=0.02), while there was no significant difference in infection rate (RR: 0.68, 95% CI: 0.38–1.22, P=0.20), pancreatic fistula rate (RR: 0.63, 95% CI: 0.35–1.16, P=0.14) and delayed gastric emptying (DGE) rate (RR: 0.72, 95% CI: 0.39–1.33, P=0.29) between the groups. In addition, EEN group had shorter hospital stay (WMD: –1.53, 95% CI: –2.12 to –0.94, P<0.001). CONCLUSIONS: Compared to TPN, EEN showed better outcomes in improving the nutritional status and bowel function as well as decreasing complication rate and hospital stay after PD in patients with pancreatic cancer.