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Background: For patients with diagnoses requiring pancreaticoduodenectomy (PD), oral intake is often limited potentially requiring feeding tube (FT) placement. We investigated if FT placement before, during or after PD was associated with altered patient outcome compared to no FT. Methods: This review included 214 patients undergoing PD for pancreatic, biliary or duodenal lesions. Eight received pre-operative FT (pre-op FT), 9 received intra-operative FT (intra-op FT), 14 received FT during their original admission for surgical resection (early FT), 17 received FT after being discharged for surgical resection (late FT), and 166 received no FT. Univariate analysis was used to compare each group to no FT controls using the Mann-Whitney U test.Results: Mean age was 63 ± 12.5 years (p=NS); 126 males were included (p=NS). There were 197 PD and 21 analogous procedures for 145 malignant and 75 benign lesions. No differences in the type of lesions resected between groups was found. Mean follow-up was 381 ± 58 days and was not different between the 5 groups. Table 1 shows post-op complications experienced by each of the 5 groups compared to no FT controls (n, % affected). Total complications for pre-op FT patients was similar to no FT while intra-op, early and late FT patients experienced more complications (p=0.0194, 0.0110 and 0.0005). At 1-, 3- and 6-months no FT patients maintained 92%, 87% and 89% of their pre-op weight while pre-op FT patients maintained 92% (p=NS), 98% (p=0.0234) and 93% (p=NS) of their pre-op weight. Conclusions: Most patients did not require FT post-op. Pre-op FT patients had minimal short-term post-op weight loss. Outcomes were not different between FT groups. Complications following PD may increase the need for post-op FT however, the placement of pre-op FT demonstrated a complication rate similar to no FT controls. The results do not justify routine intra-op FT placement.
Table 1.

	No FT	Pre-Op FT	Intra-Op FT	Early FT	Late FT
nausea	47 (28%)	2 (25%)	5 (55%)	4 (28%)	10 (58%)*
vomiting	21 (13%)	1 (13%)	0 (0%)	3 (21%)	8 (47%)*
UTI	12 (7%)	0 (0%)	2 (22%)	4 (28%)*	1 (6%)
diabetes	8 (5%)	0 (0%)	1 (11%)	2 (14%)	4 (23%)*
bacteremia	7 (4%)	2 (25%)*	4 (44%)*	3 (21%)*	3 (17%)*
delayed gastric emptying	7 (4%)	0 (0%)	1 (11%)	4 (28%)*	2 (11%)
DVT/pulmonary embolus	7 (4%)	1 (13%)	0 (0%)	3 (21%)*	0 (0%)
biliary obstruction	7 (4%)	0 (0%)	1 (11%)	1 (7%)	3 (17%)*
small bowel obstruction	5 (3%)	0 (0%)	1 (11%)	4 (28%)*	7 (41%)*
pancreatic leak	5 (3%)	0 (0%)	2 (22%)*	5 (35%)*	3 (17%)*
acute renal failure	3 (2%)	1 (13%)	2 (22%)*	0 (0%)	0 (0%)
vascular complications	3 (2%)	0 (0%)	2 (22%)*	2 (14%)	1 (6%)
altered mental status	2 (1%)	0 (0%)	1 (11%)	2 (14%)*	1 (6%)
* denotes significant p value