Feasibility Analysis of Early Removing Nasogastric Tube Following Pancreaticoduodenectomy:A Retrospective Comparative Study of Homochronous Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 TANChun-lu , ZHANGHao ,  LIKe-zhou

Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

LIKe-zhou, Email: lkzmd@hotmail.Com

Keywords：

Pancreaticoduodenectomy; Nasogastric tube; Postoperative complications

DOI：

10.7507/1007-9424.20140237

Video：

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Objective To assess the safety for removing nasogastric tube(NGT)within postoperative 24 h in Whipple pancreaticoduodenectomy (PD)patients. Methods The clinical data of 310 patients performed classic Whipple PD from January 2008 to March 2013 in this hospital were analyzed retrospectively. The patients were divided into early (≤24 h after operation)removing NGT group and late( > 24 h after operation)removing NGT group according to the time of NGT duration. The ratio of NGT reinsertion, time of solid diet tolerance, hospital stay, mortality, and major complications associated with PD were compared between two groups. Results ①The demography and preoperative comorbidities characteristics were similar(P > 0.05).②There was no statistical difference of ratio of NGT reinsertion between two groups(P=0.450).③The differences of rates of major complications associated with PD and mortality were not statistically different(P > 0.05)by univariate analysis, but the rate of total complications in the early removing NGT group was significantly lower than that in the late removing NGT group (P=0.014)by multivariate analysis.④The average time of solid diet tolerance(P=0.013)and average hospital stay(P < 0.001)in the early removing NGT group were significantly shorter than those in the late removing NGT group. Conclusion For patients comfort, NGT following PD should be removed as early as possible even immediately after extubation for selective patients.

Citation： TANChun-lu, ZHANGHao, LIKe-zhou. Feasibility Analysis of Early Removing Nasogastric Tube Following Pancreaticoduodenectomy:A Retrospective Comparative Study of Homochronous Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 985-990. doi: 10.7507/1007-9424.20140237 Copy

1.	Bassi C, Falconi M, Salvia R, et al. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients[J]. Dig Surg, 2001, 18(6): 453-458.
2.	Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy[J]. Arch Surg, 2003, 138(12): 1310-1315.
3.	Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes[J]. Ann Surg, 1997, 226(3): 248-260.
4.	Nachlas MM, Younis MT, Roda CP, et al. Gastrointestinal motility studies as a guide to postoperative management[J]. Ann Surg, 1972, 175(4): 510-522.
5.	Balzano G, Zerbi A, Braga M, et al. Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying[J]. Br J Surg, 2008, 95(11): 1387-1393.
6.	Berberat PO, Ingold H, Gulbinas A, et al. Fast track-different implications in pancreatic surgery[J]. J Gastrointest Surg, 2007, 11(7): 880-887.
7.	Kennedy EP, Rosato EL, Sauter PK, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution-the first step in multidisciplinary team building[J]. J Am Coll Surg, 2007, 204(5): 917-924.
8.	Robertson N, Gallacher PJ, Peel N, et al. Implementation of an enhanced recovery programme following pancreaticoduodenectomy[J]. HPB (Oxford), 2012, 14(10): 700-708.
9.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1): 8-13.
10.	Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition[J]. Surgery, 2007, 142(1): 20-25.
11.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5): 761-768.
12.	Sagar PM, Kruegener G, Macfie J. Nasogastric intubation and elective abdominal surgery[J]. Br J Surg, 1992, 79(11): 1127-1131.
13.	Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2005, (1): CD004929.
14.	Branagan G, Richardson L, Shetty A, et al. An enhanced recovery programme reduces length of stay after rectal surgery[J]. Int J Colorectal Dis, 2010, 25(11): 1359-1362.
15.	Gash KJ, Greenslade GL, Dixon AR. Enhanced recovery after laparoscopic colorectal resection with primary anastomosis: accelerated discharge is safe and does not give rise to increased readmission rates[J]. Colorectal Dis, 2012, 14(10): 1287-1290.
16.	Stottmeier S, Harling H, Wille-Jørgensen P, et al. Postoperative morbidity after fast-track laparoscopic resection of rectal cancer[J]. Colorectal Dis, 2012, 14(6): 769-775.
17.	Kunstman JW, Klemen ND, Fonseca AL, et al. Nasogastric drainage may be unnecessary after pancreaticoduodenectomy: a comparison of routine vs selective decompression[J]. J Am Coll Surg, 2013, 217(3): 481-488.
18.	Fisher WE, Hodges SE, Cruz G, et al. Routine nasogastric suction may be unnecessary after a pancreatic resection[J]. HPB (Oxford), 2011, 13(11): 792-796.
19.	Roig JV, García-Fadrique A, García Armengol J, et al. Use of nasogastric tubes and drains after colorectal surgery. Have attitudes changed in the last 10 years?[J]. Cir Esp, 2008, 83(2): 78-84.
20.	Lee YT. Surgery for carcinoma of the pancreas and periampullary structures: complications of resectional and palliative procedures[J]. J Surg Oncol, 1984, 27(4): 280-285.
21.	Meyer J, Sulkowski U, Bünte H, et al. Complications following duodenohemipancreatectomy. Results of 112 patients 1974-1983[J]. Zentralbl Chir, 1985, 110(20): 1242-1249.
22.	Kawai M, Yamaue H. Pancreaticoduodenectomy versus pyloruspreserving pancreaticoduodenectomy: the clinical impact of a new surgical procedure; pylorus-resecting pancreaticoduodenectomy[J]. J Hepatobiliary Pancreat Sci, 2011 Aug 23.[Epub ahead of print].
23.	Atema JJ, Eshuis WJ, Busch OR, et al. Association of preoperative symptoms of gastric outlet obstruction with delayed gastric emptying after pancreatoduodenectomy[J]. Surgery, 2013, 154(3): 583-588.
24.	Kim KH, Kim MC, Jung GJ. Risk factors associated with delayed gastric emptying after subtotal gastrectomy with Billroth-Ⅰanastomosis using circular stapler for early gastric cancer patients[J]. J Korean Surg Soc, 2012, 83(5): 274-280.
25.	Meng HB, Zhou D, Jiang X, et al. Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy[J]. World J Surg Oncol, 2013, 11: 144.
26.	Yang DD, He K, Wu XL, et al. Risk factors of gastroparesis syndrome after abdominal non-gastroduodenal operation and its prevention[J]. Asian Pac J Trop Med, 2013, 6(6): 497-499.
27.	Grantcharov TP, Kehlet H. Laparoscopic gastric surgery in an enhanced recovery programme[J]. Br J Surg, 2010, 97(10): 1547-1551.
28.	El Nakeeb A, Salah T, Sultan A, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience)[J]. World J Surg, 2013, 37(6): 1405-1418.
29.	Schmidt CM, Choi J, Powell ES, et al. Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes[J]. HPB Surg, 2009, 2009: 404520.
30.	Zhang JL, Xiao ZY, Lai DM, et al. Comparison of duct-tomucosa and end-to-side pancreaticojejunostomy reconstruction following pancreaticoduodenectomy[J]. Hepatogastroenterology, 2013, 60(121): 176-179.
31.	Ellison EC. Evidence-based management of hemorrhage after pancreaticoduodenectomy[J]. Am J Surg, 2007, 194(1): 10-12.
32.	Tien YW, Lee PH, Yang CY, et al. Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy[J]. J Am Coll Surg, 2005, 201(4): 554-559.

1. Bassi C, Falconi M, Salvia R, et al. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients[J]. Dig Surg, 2001, 18(6): 453-458.
2. Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy[J]. Arch Surg, 2003, 138(12): 1310-1315.
3. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes[J]. Ann Surg, 1997, 226(3): 248-260.
4. Nachlas MM, Younis MT, Roda CP, et al. Gastrointestinal motility studies as a guide to postoperative management[J]. Ann Surg, 1972, 175(4): 510-522.
5. Balzano G, Zerbi A, Braga M, et al. Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying[J]. Br J Surg, 2008, 95(11): 1387-1393.
6. Berberat PO, Ingold H, Gulbinas A, et al. Fast track-different implications in pancreatic surgery[J]. J Gastrointest Surg, 2007, 11(7): 880-887.
7. Kennedy EP, Rosato EL, Sauter PK, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution-the first step in multidisciplinary team building[J]. J Am Coll Surg, 2007, 204(5): 917-924.
8. Robertson N, Gallacher PJ, Peel N, et al. Implementation of an enhanced recovery programme following pancreaticoduodenectomy[J]. HPB (Oxford), 2012, 14(10): 700-708.
9. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1): 8-13.
10. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition[J]. Surgery, 2007, 142(1): 20-25.
11. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5): 761-768.
12. Sagar PM, Kruegener G, Macfie J. Nasogastric intubation and elective abdominal surgery[J]. Br J Surg, 1992, 79(11): 1127-1131.
13. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2005, (1): CD004929.
14. Branagan G, Richardson L, Shetty A, et al. An enhanced recovery programme reduces length of stay after rectal surgery[J]. Int J Colorectal Dis, 2010, 25(11): 1359-1362.
15. Gash KJ, Greenslade GL, Dixon AR. Enhanced recovery after laparoscopic colorectal resection with primary anastomosis: accelerated discharge is safe and does not give rise to increased readmission rates[J]. Colorectal Dis, 2012, 14(10): 1287-1290.
16. Stottmeier S, Harling H, Wille-Jørgensen P, et al. Postoperative morbidity after fast-track laparoscopic resection of rectal cancer[J]. Colorectal Dis, 2012, 14(6): 769-775.
17. Kunstman JW, Klemen ND, Fonseca AL, et al. Nasogastric drainage may be unnecessary after pancreaticoduodenectomy: a comparison of routine vs selective decompression[J]. J Am Coll Surg, 2013, 217(3): 481-488.
18. Fisher WE, Hodges SE, Cruz G, et al. Routine nasogastric suction may be unnecessary after a pancreatic resection[J]. HPB (Oxford), 2011, 13(11): 792-796.
19. Roig JV, García-Fadrique A, García Armengol J, et al. Use of nasogastric tubes and drains after colorectal surgery. Have attitudes changed in the last 10 years?[J]. Cir Esp, 2008, 83(2): 78-84.
20. Lee YT. Surgery for carcinoma of the pancreas and periampullary structures: complications of resectional and palliative procedures[J]. J Surg Oncol, 1984, 27(4): 280-285.
21. Meyer J, Sulkowski U, Bünte H, et al. Complications following duodenohemipancreatectomy. Results of 112 patients 1974-1983[J]. Zentralbl Chir, 1985, 110(20): 1242-1249.
22. Kawai M, Yamaue H. Pancreaticoduodenectomy versus pyloruspreserving pancreaticoduodenectomy: the clinical impact of a new surgical procedure; pylorus-resecting pancreaticoduodenectomy[J]. J Hepatobiliary Pancreat Sci, 2011 Aug 23.[Epub ahead of print].
23. Atema JJ, Eshuis WJ, Busch OR, et al. Association of preoperative symptoms of gastric outlet obstruction with delayed gastric emptying after pancreatoduodenectomy[J]. Surgery, 2013, 154(3): 583-588.
24. Kim KH, Kim MC, Jung GJ. Risk factors associated with delayed gastric emptying after subtotal gastrectomy with Billroth-Ⅰanastomosis using circular stapler for early gastric cancer patients[J]. J Korean Surg Soc, 2012, 83(5): 274-280.
25. Meng HB, Zhou D, Jiang X, et al. Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy[J]. World J Surg Oncol, 2013, 11: 144.
26. Yang DD, He K, Wu XL, et al. Risk factors of gastroparesis syndrome after abdominal non-gastroduodenal operation and its prevention[J]. Asian Pac J Trop Med, 2013, 6(6): 497-499.
27. Grantcharov TP, Kehlet H. Laparoscopic gastric surgery in an enhanced recovery programme[J]. Br J Surg, 2010, 97(10): 1547-1551.
28. El Nakeeb A, Salah T, Sultan A, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience)[J]. World J Surg, 2013, 37(6): 1405-1418.
29. Schmidt CM, Choi J, Powell ES, et al. Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes[J]. HPB Surg, 2009, 2009: 404520.
30. Zhang JL, Xiao ZY, Lai DM, et al. Comparison of duct-tomucosa and end-to-side pancreaticojejunostomy reconstruction following pancreaticoduodenectomy[J]. Hepatogastroenterology, 2013, 60(121): 176-179.
31. Ellison EC. Evidence-based management of hemorrhage after pancreaticoduodenectomy[J]. Am J Surg, 2007, 194(1): 10-12.
32. Tien YW, Lee PH, Yang CY, et al. Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy[J]. J Am Coll Surg, 2005, 201(4): 554-559.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Feasibility Analysis of Early Removing Nasogastric Tube Following Pancreaticoduodenectomy:A Retrospective Comparative Study of Homochronous Patients

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