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

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Abstract
Introduction: Postoperative nutrition after pancreatoduodenectomy (PD) remains controversial. Although many centers routinely place a feeding jejunostomy tube (FJT) after PD, it is associated with morbidity. We conducted this study to compare the perioperative outcomes with and without FJT placement post‐PD. Methods: This was an open‐label randomized controlled trial, in which the FJT was placed in one arm and the nasojejunal tube (NJT) in the other. All patients with periampullary neoplasm who underwent pylorus resecting PD were included in this study. The primary outcome assessed was clinically relevant delayed gastric emptying (CR‐DGE), and the secondary outcomes were clinically relevant postoperative pancreatic fistula (CR‐POPF), postoperative complications, and hospital stay. Results: Forty patients were allocated to the FJT and NJT groups, and the two groups were comparable in baseline demographics, disease characteristics, and perioperative outcomes, including CR‐POPF rates. The FJT group had a significantly higher CR‐DGE rate (55% vs. 25%, p = 0.006), required increased use of prokinetic drugs (77.5% vs. 45%, p = 0.003), and had a longer median postoperative hospital stay (11 vs. 9 days, p = 0.007). Both groups had similar tube‐related complications. In the NJT group, 22.5% of the patients with CR‐DGE required parenteral nutrition. On multivariate analysis, the presence of FJT [adjusted odds ratio (aOR), 6.030 (1.431–25.402), p = 0.014] and intra‐abdominal collection [aOR, 7.108 (1.026–49.224), p = 0.047] were independent risk factors for CR‐DGE. Conclusion: Post‐PD placement of FJT was an independent risk factor for CR‐DGE. Hence, the routine use of the FJT can be omitted after PD without compromising postoperative morbidity and nutrition. Trial Registration: The trial was registered with the Clinical Trial Register with CTRI number: CTRI/2021/02/030942 ( https://ctri.nic.in/Clinicaltrials/advancesearchmain.php )

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