Avoiding nasogastric decompression safe after pancreaticoduodenectomy: JAMA
France: Avoiding nasogastric tube decompression (NGTD) after pancreaticoduodenectomy (PD) is safe, suggests a recent study in the journal JAMA Surgery. According to the study, there were no significant differences in the postoperative complications in patients subjected to systematic NGTD and no NGTD after PD.
Standardization of PD although has improved postoperative outcomes but morbidity remains high. Avoiding NGTD that is already outdated in major abdominal surgery is suggested after PD by fast track surgery programs. But there is a lack of high-level evidence, especially in regard to its safety.
Damien Bergeat, University of Rennes, Rennes, France, and colleagues assessed whether the absence of systematic NGTD after PD reduces postoperative complications, in a randomized clinical trial.
The IPOD study (Impact of the Absence of Nasogastric Decompression After Pancreaticoduodenectomy) was an open-label, prospective, single-center, randomized clinical trial. This was conducted at a high-volume pancreatic surgery university hospital in France. The researchers screened a total of 155 patients aged 18 to 75 years and required PD for benign or malignant disease. Key exclusion criteria were previous gastric or esophageal surgery and severe comorbidities.
The patients were randomly assigned in the ratio 1:1 to receive systematic NGTD or no nasogastric decompression and were followed up until 90 days after surgery. For patients without NGTD, the NGT was removed immediately after surgery, whereas for patients with NGTD, the NGT was removed 3 to 5 days after surgery.
The primary endpoint was the occurrence of postoperative complications grade II or higher using the Clavien-Dindo classification.
Key findings of the study include:
- From January 2016 to August 2018, 125 screened patients were considered eligible for the study, and 111 were randomized to no NGTD (n = 52) or to NGTD (n = 59).
- No patient was lost to follow-up. The 2 groups had similar patient demographic and clinical characteristics at baseline.
- The median (interquartile range) age was 63.0 years in the group with NGTD (38 [64.4%] were males) and 64.0 years in the group without NGTD (31 [59.6%] were males).
- The postoperative complication rates grade II or higher were similar between the 2 groups (risk ratio, 0.99).
- Pulmonary complication rates (risk ratio, 0.59) and delayed gastric emptying rates (risk ratio, 1.07) were not significantly different between the groups.
- Median (interquartile) length of hospital stay for patients without NGTD was not significantly different compared with those with NGTD (10.0 vs 12.0 days).
"Our study found no significant difference in postoperative complication occurrence of Clavien-Dindo classification grade II or higher between systematic NGTD and no NGTD after PD, suggesting that avoiding systematic nasogastric decompression is safe for this indication," concluded the authors.
The study, "Nasogastric Decompression vs No Decompression After Pancreaticoduodenectomy: The Randomized Clinical IPOD Trial," is published in the journal JAMA Surgery.
