Total parenteral nutrition utilizing evaluation after

Pylorus-preserving pancreatoduodenectomy(PPPD)

Kim Sung Eun°, Park Yun Hee, Kim Jae Youn, Song Young Cheon

Department of Pharmacy, Asan Medical Center

PPPD is considered the treatment of choice for various periampullary diseases. Patients undergoing PPPD require postoperative artificial nutrition, there is no guideline yet. The aim of this study is to evaluate use of total parenteral nutrition(TPN) after PPPD in order to identify standard protocol. A retrospective study was conducted, patients who had undergone PPPD and received TPN from January to June 2007 in Asan Medical Center. Evaluations of TPN utilizing were accessed by supplemented calories and duration of TPN. Outcomes include nutritional status change, morbidity, mortality and length of hospital stay. 69 patients were enrolled in this study, 62 patients were malnourished. The preoperative nutritional status got worse, the duration of TPN and length of hospital stay were longer. The supported calorie and protein was 36.41kcal/kg and 1.42g/kg. It was excessive than the recommended amount(32.72kcal/kg,1.34g/kg) that was considered patients' nutritional status. We classified patients by the ratio of supplied/recommended alimentation; under-calorie(<90;n=8), adequate calorie(90-120;n=39) and over-calorie(>120;n=22) groups. The duration of TPN (9.8d,10.69d and 9.59d) and length of postoperative hospital stay(22.1d,23.5d and 23d) were not statistically different. The rate of metabolic abnormalities and infectious complications were higher in

over-calorie group(82 and 27.8) than other groups(72 and 17). Major complications such as fistula, anastomotic leakage (12.5,17.9 and 9.1) were not significantly

different. In this study, excessive calorie supplementation had no significant benefit on the outcome after PPPD. Therefore we should support adequate amount of nutrition with consideration of patients' nutritional status as well as cost-benefit aspect.