A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy

In this prospective trial, the authors examined the impact of post-operative parenteral nutrition on surgery-associated complications in patients with pancreatic cancer. A total of 117 patients operated for pancreatico-duodenectomy were included in this study and randomly selected to receive (n = 60) or not to receive (n = 57) TPN postoperatively. The TPN formula delivered 1 g protein/kg/d, 30 to 35 kcal/kg/d; the caloric source was 70% glucose and 30% fat. In the control group, patients received dextrose-containing salt solutions. Nutrition was maintained until oral intake exceeded 1000 kcal/d (mean = 12 days). Minor and major postoperative complications were recorded during hospital stay (mean = 15 days). Pre-operative nutritional impairment was moderate (mean body weight loss = 6%, serum albumin = 32 g/l). No difference of any studied parameter was noted, except for major complications (n = 27 in TPN vs 13 in control) and complications that could be modified by TPN (+185% in TPN). Median length of stay and overall survival (median follow-up = 18 months) was the same for both groups. The authors conclude that routine use of postoperative TPN for patients undergoing major pancreatic surgery is not justified.