Abstract:Background and Aims Laparoscopic pancreaticoduodenectomy (LPD) has become a preferred approach for periampullary tumors, yet delayed gastric emptying (DGE) remains a frequent complication that hampers postoperative recovery. The nasojejunal feeding tube (NJT) is commonly used for early enteral nutrition, but its impact on DGE is controversial. This study aimed to evaluate whether intraoperative NJT placement increases the risk of DGE after LPD and to assess its influence on postoperative recovery outcomes.Methods A retrospective cohort of 319 patients who underwent LPD at Provincial Hospital Affiliated to Shandong First Medical University from April 2017 to November 2023 was analyzed. Patients were divided into two groups based on intraoperative NJT placement (NJT group, n=200; non-NJT group, n=119). The incidence of DGE and postoperative outcomes were compared. Multivariate logistic regression and propensity score matching (PSM) were performed to identify independent risk factors for DGE.Results The incidence of grade B/C DGE was significantly higher in the NJT group than in the non-NJT group (36.5% vs. 21.8%, P=0.006). NJT placement was associated with longer postoperative hospital stay and higher hospitalization costs (both P<0.05). Multivariate analysis revealed intraoperative NJT placement (OR=1.960, 95% CI=1.142-3.363, P=0.015) and intraoperative blood loss >400 mL (OR=1.921, 95% CI=1.155-3.194, P=0.012) as independent risk factors for DGE. These findings were consistent after PSM.Conclusions Prophylactic intraoperative NJT placement confers no additional benefit for postoperative recovery after LPD and is associated with a higher risk of DGE, prolonged hospitalization, and increased medical costs. Routine NJT placement should therefore be avoided, and individualized strategies should be adopted to minimize postoperative complications and enhance recovery