Early oral nutritional supplementation combined with graded functional exercise for postoperative recovery in patients undergoing pancreaticoduodenectomy.

INTRODUCTION: pancreaticoduodenectomy (PD) leads to high malnutrition and complication rates, while early oral nutritional supplementation (ONS) and graded exercise each benefit postoperative recovery. OBJECTIVE: to assess the effects of ONS combined with graded functional exercise on postoperative recovery in patients with pancreatic neoplasms undergoing PD. METHODS: a total of 87 patients with pancreatic neoplasms admitted between June 2024 and December 2025 were enrolled and randomly assigned to a control group (n = 43) and an intervention group (n = 44). The control group received standard postoperative Enhanced Recovery After Surgery (ERAS) care, whereas the intervention group received early ONS combined with graded functional exercise initiated within 48 hours postoperatively in addition to standard ERAS care. RESULTS: when compared with the control group, the intervention group demonstrated significantly shorter time to oral feeding, time to first flatus, time to first defecation, and time to first ambulation (p < 0.05). Serum prealbumin levels on postoperative day 7 were significantly higher in the intervention group (p < 0.05). By postoperative day 14, the intervention group exhibited significantly higher levels of serum prealbumin, albumin, and hemoglobin, along with improved skeletal muscle mass, handgrip strength, and calf circumference compared with the control group (p < 0.05). CONCLUSION: early initiation of ONS combined with graded functional exercise following PD in patients with pancreatic neoplasms was associated with improved postoperative nutritional status, attenuation of skeletal muscle loss, and enhanced recovery of gastrointestinal and physical function, thereby supporting subsequent treatment.