{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:17:17Z","timestamp":1787318237337,"version":"build-2736575974"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T00:00:00Z","timestamp":1570665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>\n                      Evidence of nutritional therapies in pancreatoduodenectomy (\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      ) has been shown. However, few studies focus on the association between different nutritional therapies and outcomes. The aim of this review was to summarize the current evidence of nutritional therapies such as enteral nutrition (\n                      <jats:styled-content style=\"fixed-case\">EN<\/jats:styled-content>\n                      ), immunonutrition, and synbiotics on postoperative outcomes after\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic literature search of Embase, Medline Ovid, and Cochrane\n                      <jats:styled-content style=\"fixed-case\">CENTRAL<\/jats:styled-content>\n                      was done to summarize the available evidence, including randomized controlled trials, meta\u2010analyses and reviews, regarding nutritional therapy in\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 20 randomized controlled trials were included in this review. Safety and tolerability of\n                      <jats:styled-content style=\"fixed-case\">EN<\/jats:styled-content>\n                      in\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      was shown. Giving postoperative\n                      <jats:styled-content style=\"fixed-case\">EN<\/jats:styled-content>\n                      can shorten length of stay compared to parenteral nutrition; however, the effect of\n                      <jats:styled-content style=\"fixed-case\">EN<\/jats:styled-content>\n                      on postoperative complications remains controversial. Postoperative\n                      <jats:styled-content style=\"fixed-case\">EN<\/jats:styled-content>\n                      should be given only on selective indications rather than routinely used, and preoperative\n                      <jats:styled-content style=\"fixed-case\">EN<\/jats:styled-content>\n                      is indicated only in patients with severe malnutrition. Giving preoperative immunonutrition is considered to reduce the incidence of infectious complications; however, evidence level is moderate and recommendation grade is weak. The beneficial effect of perioperative synbiotics on postoperative infectious complications is limited. Furthermore, the effectiveness of other nutritional supplements remains unclear.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Recently, evidence of enhanced recovery after surgery (\n                      <jats:styled-content style=\"fixed-case\">ERAS<\/jats:styled-content>\n                      ) in\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      has been increasing. Early oral intake with systematic nutritional support is an important aspect of the\n                      <jats:styled-content style=\"fixed-case\">ERAS<\/jats:styled-content>\n                      concept. Future well\u2010designed studies should investigate the impact of systematic nutritional therapies on outcomes following\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.12287","type":"journal-article","created":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T13:41:55Z","timestamp":1570714915000},"page":"620-629","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Current evidence of nutritional therapy in pancreatoduodenectomy: Systematic review of randomized controlled trials"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2267-2441","authenticated-orcid":false,"given":"Kosei","family":"Takagi","sequence":"first","affiliation":[{"name":"Department of Surgery Erasmus MC University Medical Center Rotterdam Rotterdam The 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