Recovery of oral NUTRItion after PANCreatic surgery (NUTRIPANC): Results from a prospective cohort study

Background & aims: Early oral feeding is a key component of enhanced recovery pathways (ERPs) after pancreatic resection, yet achievement of recommended postoperative nutritional targets remains poorly characterized. This study aimed to assess recovery of oral intake during the first postoperative week after pancreatic surgery, identify predictors of failure to achieve a predefined caloric target, and evaluate the association between target achievement and postoperative outcomes. Methods: This was a secondary analysis of a prospective cohort study including adult patients undergoing pancreatic resection at a high-volume center between June 2020 and June 2022. Daily oral caloric and protein intake were prospectively recorded from postoperative day (POD) 1to POD7. Adherence was defined as achievement of at least 50% of 25 kcal/kg/day by POD7, in line with ESPEN recommendations. Multivariable logistic regression was used to identify predictors of non-adherence, and adjusted regression models assessed the association between adherence and postoperative outcomes. Results: Overall, 303 patients were included; the median age was 66 years, 66% had malignant disease, and 64% underwent proximal resection. Median energy intake increased from 77 (IQR 0-205) kcal/day on POD1 to 762 (IQR 540-1268) kcal/day on POD7, while protein intake increased from 2 g/day to 29 g/ day. By POD7, 210 patients (69%) had not achieved the caloric target and 202 (67%) had not achieved the protein target. Older age (OR 1.03, 95%CI 0.99-1.06; p = 0.058), malignancy (OR 1.93, 1.02-3.62; p = 0.043), higher fat-free mass index (OR 1.24, 1.08-1.42; p = 0.002), and higher fat mass index (OR 1.15, 1.03-1.30; p = 0.023) were independently associated with non-adherence. After adjustment, energy target achievement was not associated with length of stay or morbidity burden, whereas greater adherence to postoperative ERP elements was associated with better outcomes. Conclusion: After pancreatic resection, fewer than one-third of patients achieved the recommended energy and protein target within the first week. Failure to achieve the caloric target was not independently associated with worse short-term outcomes, supporting a selective rather than routine use of early medical nutrition therapy. (c) 2026 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights are reserved, including those for text and data mining, AI training, and similar technologies.