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Santos SS, Costa LATJD, Araripe TSDO, Reges BDLO, Ximenes HMDA, Moreira ACDOM. Immunomodulatory enteral nutrition in post-surgical gastrointestinal cancer: Clinical, biochemical and nutritional impacts. Clin Nutr ESPEN 2025; 68:254-262. [PMID: 40374110 DOI: 10.1016/j.clnesp.2025.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2025] [Accepted: 05/02/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND Evidence shows that most gastrointestinal cancer patients develop malnutrition, which may contribute to immune function depression; inflammatory response disturbance, and stress response exacerbation, making these patients often present bad surgical results such as infections, delayed surgical wound healing, and longer hospital stays. One of the proposed nutritional strategies to combat this situation is immunonutrition, which provides nutrients that modulate the immune system activity and has been associated with better results in critically ill and surgical oncologic patients. However, the results regarding its efficiency are controversial. Thus, this article aims to evaluate the clinical, biochemical, and nutritional effects of enteral immunonutrition in patients submitted to gastrointestinal cancer surgery. METHODS A randomized nutritional intervention study was developed in a reference hospital for oncological treatment. Gastrointestinal cancer patients undergoing surgical treatment were randomized into two groups: one receiving standard enteral nutrition and the other receiving immunomodulatory enteral nutrition. Baseline, clinical, and nutritional data were collected. Nutritional support was started immediately after surgery when clinically recommended, and its effects on clinical, biochemical, and nutritional markers were assessed. RESULTS 100 patients were divided into two groups, 50 in each group. It was observed lower frequency in cases of diarrhea and post-surgical complications such as fistula and sepsis, lower gastric residue, and best parameters related to the nutritional status of iron and vitamin B12, a better immune pattern such as a higher number of lymphocytes and less than leukocytes, lower values of inflammatory acute phase proteins and significantly higher Albumin/Globulin ratio in the group receiving immunomodulatory enteral nutrition, suggesting an improvement in the profile of inflammatory markers. CONCLUSIONS Results suggest that immunomodulatory nutritional support for patients with gastrointestinal tract cancer submitted to surgery may promote a reduction in severe postoperative complications, such as fistula with sepsis and evisceration, and improve markers of immune function and renal efficiency.
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Affiliation(s)
- Semíramis Silva Santos
- Instituto do Câncer do Ceará (ICC), RENORBIO, Universidade Estadual do Ceará (UECE), Fortaleza, Ceará, Brazil.
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Budny A, Janczy A, Mika A. New Approaches to the Treatment of Severe Obesity-Prehabilitation as the Key to Success. Curr Nutr Rep 2025; 14:64. [PMID: 40299104 DOI: 10.1007/s13668-025-00652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2025] [Indexed: 04/30/2025]
Abstract
PURPOSE OF REVIEW Bariatric surgery (BS) has emerged as a crucial and effective treatment for severe obesity (SO), providing significant and sustained weight loss and improving comorbidities. Optimizing perioperative careparticularly through structured prehabilitation is crucial for improving surgical outcomes and long-term weight management. This review examines the role of prehabilitation, nutrition, psychological support, physical activity, and pharmacologic treatment in improving the effectiveness of BS. RECENT FINDINGS Despite the benefits of prehabilitation, there are significant differences in the way it is implemented in different healthcare centers. Protocols vary widely in terms of duration, components and intensity, leading to inconsistencies in patient preparation and postoperative recovery. Many patients still do not receive multidisciplinary support from dietitians, psychologists or physiotherapists prior to surgery, which can affect long-term outcomes. Barriers to effective prehabilitation include a lack of standardized guidelines, insufficient healthcare resources and limited patient adherence due to lack of awareness, low motivation or logistical constraints. Despite its proven benefits, structured prehabilitation lasting at least 3-6 months is not available to all patients, as access remains unequal and suboptimal in many healthcare settings. Prehabilitation is an important but underutilized component of BS preparation. Standardizing protocols and ensuring multidisciplinary, patient-centered support are essential to maximizing surgical benefit. Overcoming barriers such as healthcare system limitations, patient motivation and knowledge gaps is critical to integrating prehabilitation into routine bariatric care. This review emphasizes the need for evidence-based, multimodal prehabilitation strategies to improve perioperative care and long-term outcomes for BS patients.
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Affiliation(s)
- Aleksandra Budny
- Division of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Agata Janczy
- Division of Food Commodity Science, Faculty of Health Sciences With the Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Adriana Mika
- Department of Environmental Analytics, Faculty of Chemistry, University of Gdansk, Gdansk, Poland.
- Department of Pharmaceutical Biochemistry, Medical University of Gdansk, Gdansk, Poland.
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Yuan Y, Luo S, Wang X, Zheng Z, Qi Q, Wang Y, Chen M, Yang H, Gu P, Du Q, Wu X, Pan W, Xu Y, Wang J. Efficacy and safety of concurrent programmed cell death protein 1 inhibitor and definitive radiotherapy with immunonutrition support in esophageal squamous cell cancer: a phase II multicenter clinical trial. Radiat Oncol 2025; 20:58. [PMID: 40251674 PMCID: PMC12007264 DOI: 10.1186/s13014-025-02604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 02/17/2025] [Indexed: 04/20/2025] Open
Abstract
BACKGROUND Esophageal cancer is one of the most common malignant tumors, with China accounting for 50% of the world's total incidence. Concurrent chemoradiotherapy (cCRT) with platin-based dual-drug regimen is the standard treatment for inoperable, locally advanced esophageal cancer in patients with a good performance status. However, certain patients possess risk factors that heighten toxicity and reduce their tolerance to cCRT, thereby challenging the feasibility of standard treatment. This study evaluates an alternative therapeutic approach combining programmed cell death protein 1 inhibitor (PD-1 inhibitor), definitive radiotherapy, and immunonutrition support for patients with unresectable non-metastatic esophageal cancer expressing PD-L1 who are intolerant to cCRT. METHODS This is a phase II, single-arm, multicenter clinical trial involving patients with histologically confirmed unresectable esophageal squamous cell carcinoma (ESCC), who exhibit positive PD-L1 and are unsuitable for cCRT. Participants will receive a total radiotherapy dose of 50-60 Gy in 25-30 fractions, sintilimab (200 mg every three weeks), alongside, supplemented by enteral nutritional emulsion (600-1600 ml/day). The primary endpoint is the 1-year progression-free survival rate, with secondary endpoints including objective response rate, overall survival and incidence of adverse events. CONCLUSION This research has the potential to redefine treatment for inoperable ESCC patients who cannot tolerate conventional therapies. By evaluating a less toxic regimen that combines immunotherapy, radiotherapy, and nutritional support, we aim to determine if this approach can improve both survival rates and quality of life. The synergistic effects of immunonutrition support and PD-1 inhibitor will also be explored. TRIAL REGISTRATION NCT06342167.
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Affiliation(s)
- Yupei Yuan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P. R. China
| | - Shihong Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P. R. China
| | - Xiaomin Wang
- Department of Radiation Oncology, Anyang Tumor Hospital, Anyang, Henan Province, 518116, China
| | - Zhiyong Zheng
- Department of Radiation Oncology, Anyang Tumor Hospital, Anyang, Henan Province, 518116, China
| | - Qing Qi
- Department of Oncology, Affiliated Hospital of Hebei University of Engineering, Baoding, Hebei Province, 056002, China
| | - Yunxiao Wang
- Department of Oncology, Affiliated Hospital of Hebei University of Engineering, Baoding, Hebei Province, 056002, China
| | - Meiling Chen
- Department of Radiation Oncology, the First Affiliated Hospital of Xinxiang Medical University, Xinjiang, Henan Province, 453199, China
| | - Haihua Yang
- Taizhou hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 317000, China
| | - Pingjun Gu
- Taizhou hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 317000, China
| | - Qin Du
- Department of Radiation Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, 272004, China
| | - Xia Wu
- Department of Radiation Oncology, Fei County People's Hospital, Jinan, Shandong Province, 031899, China
| | - Wenyan Pan
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Province, 750003, China
| | - Yuanji Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, 350014, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P. R. China.
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Cianflone F, Tartara A, Aretano L, Da Prat V, Ringressi A, Marchetti C, Lonati C, Gambini G, Caccialanza R, Naspro R. Effect of Perioperative Immunonutrition on Early-Postoperative Complications in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Case Series. J Clin Med 2025; 14:1992. [PMID: 40142800 PMCID: PMC11943039 DOI: 10.3390/jcm14061992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 01/26/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025] Open
Abstract
Objective: The objective was to evaluate the impact of perioperative immunonutrition (IN) on postoperative complications in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Methods: A prospective case series of 19 patients treated with perioperative IN between October 2022 and July 2023 was conducted. Patients received preoperative IN based on nutritional risk and postoperative IN with gradual recovery of normal feeding. The inclusion criteria encompassed clinically node-negative patients without metastatic disease. The outcomes were assessed using Clavien-Dindo classification and included infectious complications, wound healing disorders, ileus, anemia, genitourinary issues, recovery time, and compliance with the nutritional regimen. Results: Sixteen patients (84.2%) experienced complications. Most were low-grade (CD 1-2), with no CD > 3a. Wound disorders affected 10.5% and anemia requiring transfusion occurred in 47.4% of patients, infectious complications were reported in 26.3%, and ileus in 36.8%. The median time to first flatus was 2 days (IQR 2-3), while resumption of oral feeding occurred after 4 days (IQR 2-5), like mobilization (IQR 2-5). The median hospital stay was 14 days (IQR 11-18). Compliance with IN was 78.9%, with gastrointestinal intolerance being the primary cause of discontinuation. Conclusions: Patients with RC undergoing perioperative IN showed low rates of high-grade complications and promising results in bowel function recovery and infection rates. Further randomized controlled trials are required to validate these results.
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Affiliation(s)
- Francesco Cianflone
- Department of Urology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alice Tartara
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lucia Aretano
- Department of Urology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Valentina Da Prat
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Ringressi
- Department of Urology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Carlo Marchetti
- Department of Urology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Chiara Lonati
- Department of Urology, Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Giulia Gambini
- Clinical Epidemiology and Biometry Service, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Richard Naspro
- Department of Urology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Wong CS, Zaman S, Siddiraju K, Sellvaraj A, Ghattas T, Tryliskyy Y. Effects of enteral immunonutrition in laparoscopic versus open resections in colorectal cancer surgery: A meta-analysis of randomised controlled trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109488. [PMID: 39708458 DOI: 10.1016/j.ejso.2024.109488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 10/31/2024] [Accepted: 11/22/2024] [Indexed: 12/23/2024]
Abstract
INTRODUCTION Immunonutrition (IMN) modulates the activity of the immune system. However, the effects of IMN on cancer patients following colorectal surgery is still lacking. We performed a systematic review and meta-analysis to evaluate the outcomes of IMN in patients undergoing laparoscopic versus open colorectal surgery. METHODS A systematic search of multiple electronic data sources was conducted in accordance with PRISMA guidelines and included MEDLINE via PubMed, EMBASE, Scopus, and Web of Science. All eligible studies reporting comparative outcomes of immunonutrition in colorectal surgery were included. Subgroup analysis of outcomes of interest was performed and data were analysed using Review Manager (RevMan) Version 5.4.1. RESULTS Nine randomised controlled trials (RCTs) were identified. The final pooled analysis included 1199 patients (592 IMN group and 592 control group). Of these, 55.3 % (655/1184) had open colorectal surgery (OG) and 44.7 % (529/1184) underwent laparoscopic colorectal surgery (LG). IMN reduced the risk of wound infection significantly in the OG [risk ratio (RR) 0.48, 95 % confidence interval (CI) 0.32 to 0.72; p = 0.0005)] and the open and laparoscopic group (OLG) [RR 0.33, 95 % CI 0.15 to 0.76; p = 0.008]. Moreover, IMN was also associated with a significantly shorter length of hospital stay (MD - 2.37 days, 95 % CI - 3.39 to -1.36; p < 0.0001) in the OG. Other post-operative morbidities (anastomotic leak and ileus) and mortality outcomes in the OG, LG, and OLG were comparable. CONCLUSIONS Pre-operative IMN could reduce the wound infection rate and shorten length of hospital stay in patients following elective colorectal surgery. The benefit of these improved clinical outcomes could be further evaluated with a cost-benefit analysis. IMN should be recommended as nutritional adjunct in the Enhanced Recovery after Surgery (ERAS) pathway following colorectal surgery.
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Affiliation(s)
- Chee Siong Wong
- Queen Elizabeth University Hospital, Birmingham, UK; University of Birmingham, Birmingham, UK.
| | | | | | | | - Tariq Ghattas
- Queen Elizabeth University Hospital, Birmingham, UK.
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Markar S, Mariette C, Bonnetain F, Lundell L, Rosati R, de Manzoni G, Bonavina L, Tucker O, Plum P, D'Journo XB, Van Daele D, Cogill G, Santi S, Farran L, Iranzo V, Pera M, Veziant J, Piessen G. Immunonutrition to improve the quality of life of upper gastrointestinal cancer patients undergoing neoadjuvant treatment prior to surgery (NEOIMMUNE): double-blind randomized controlled multicenter clinical trial. Dis Esophagus 2025; 38:doae113. [PMID: 39863958 DOI: 10.1093/dote/doae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 09/21/2024] [Accepted: 11/29/2024] [Indexed: 01/27/2025]
Abstract
BACKGROUND Malnutrition is common with esophagogastric cancers and is associated with negative outcomes. We aimed to evaluate if immunonutrition during neoadjuvant treatment improves patient's health-related quality of life (HRQOL) and reduces postoperative morbidity and toxicities during neoadjuvant treatment. METHODS A multicenter double-blind randomized controlled trial (RCT) was undertaken. Included patients had untreated nonmetastatic esophagogastric tumor, aged 18 ≥ years with a life expectancy of >3 months. The study was powered for 80% power to detect a clinically relevant difference in EORTC-QLQC30 with standard deviation of 15 between groups. Primary end point was the quality of life as measured by the global health status at 30 days after surgery. An intention-to-treat analysis was employed. RESULTS The study was terminated at the interim analysis stage. About 300 patients were randomized: 149 to the IMPACT group and 151 to the control-formula group. Patient groups were well-balanced in terms of age, sex, body mass index, WHO performance status, and clinical tumor stage. Analysis of the primary end point for the study of global health status at 30-day postoperatively failed to show any significant differences between the groups (55.4 ± 18.6 [IMPACT] vs. 55.9 ± 19.8 [control]; P = 0.345). No significant differences between the groups were detected in the majority of domains from EORTC QLQC30 and OG25 tools after neoadjuvant therapy and 30 days postoperatively. Finally, no significant differences were seen between groups in neoadjuvant therapy or postoperative complications, or tumor response. CONCLUSION The results of this multicenter double-blind RCT fail to demonstrate any HRQOL benefits to the utilization of immunonutrition during neoadjuvant therapy in patients with esophagogastric cancer.
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Affiliation(s)
- Sheraz Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, Chu Lille, Lille, France
| | - Frank Bonnetain
- Methodology and Quality of Life Unit in Cancer, INSERM UMR 1098, University Hospital of Besançon, Besançon, France
| | - Lars Lundell
- Department of Clinical Sciences Intervention and Technology, Karolinska institutet, Stockholm, Sweden
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | | | - Luigi Bonavina
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Olga Tucker
- Department of Surgery, University of Birmingham, Birmingham, UK
| | - Patrick Plum
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Xavier Benoit D'Journo
- Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Daniel Van Daele
- Department of Gastro-enterology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Geoff Cogill
- Department of Oncology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Stefano Santi
- Esophageal Surgery Unit, Gastroenterology Department, Regional Referral Center for Diagnosis and Treatment of Diseases of Esophagus, "Nuovos. Chiara" Hospital, Pisa, Italy
| | - Leandres Farran
- Digestive Surgery Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Vega Iranzo
- Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Manuel Pera
- Sección de Cirugía Gastrointestinal, Servicio de Cirugía, Hospital Universitario del Mar, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julie Veziant
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, Chu Lille, Lille, France
- Univ. Lille, CNRS, Inserm, Chu Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, Chu Lille, Lille, France
- Univ. Lille, CNRS, Inserm, Chu Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
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Koo TH, Leong XB, Zakaria AD. Current Trend and Outcomes on Immunonutrition in Medical and Surgical Fields: An Updated Perspective. Malays J Med Sci 2024; 31:65-76. [PMID: 39830099 PMCID: PMC11740823 DOI: 10.21315/mjms2024.31.6.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/22/2024] [Indexed: 01/22/2025] Open
Abstract
Immunonutrition, which involves the targeted use of specific nutrients to enhance immune function and mitigate inflammation, has recently become a mainstay for both medical and surgical benefits. This review explores the evolution, mechanisms, and clinical applications of immunonutrition, with a focus on essential nutrients, such as omega-3 fatty acids, glutamine, arginine, and vitamins. These immunonutrients modulate immune responses, reduce pro-inflammatory cytokines, and support tissue repair. Clinical evidence indicates that immunonutrition reduces postoperative complications, shortens the duration of hospitalisation, and lowers the rate of infection, mainly in high-risk surgical patients and those with cancer or chronic diseases. In this regard, nutrients such as glutamine and omega-3 fatty acids have improved the nutritional status and recovery of cancer patients, while omega-3 fatty acids and antioxidant vitamins have exerted an anti-inflammatory effect, improving heart health in patients with cardiovascular disease. Immunonutrition has bright prospects in the management of infectious diseases, where certain nutrients, including vitamin D and zinc, aid in fighting immune defences and reducing the severity of infection. Future studies should investigate the molecular mechanisms underlying immunonutrition and its role in personalised nutrition. This could revolutionise dietary interventions based on genetic and proteomic profiling.
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Affiliation(s)
- Thai Hau Koo
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Xue Bin Leong
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Madini N, Vincenti A, Beretta A, Santero S, Viroli G, Cena H. Addressing Inflammaging and Disease-Related Malnutrition: Adequacy of Oral Nutritional Supplements in Clinical Care. Nutrients 2024; 16:4141. [PMID: 39683535 DOI: 10.3390/nu16234141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 11/26/2024] [Accepted: 11/27/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Disease-related malnutrition, with or without inflammation, in older adults is currently emerging as a public health priority. The use of Foods for Special Medical Purposes, including Oral Nutritional Supplements, and supplements is crucial to support patients in achieving their nutritional needs. Therefore, this article aims to comprehensively provide an analysis of the adequacy of FSMPs in meeting the nutritional requirements of different age-related diseases and takes into account the emerging role of inflammation. Moreover, it provides an identikit of the ideal products, following the pathology-specific guidelines. METHODS Data on 132 products were gathered through face-to-face meetings with companies' consultants. Specifically, information on energy, macronutrient, and micronutrient contents were collected, as well as on texture and flavors, osmolarity, cost, and packaging. RESULTS Most FSMPs met the daily recommendations for energy and protein intake. Nonetheless, few products contained β-hydroxy-β-methylbutyrate, optimal Branched-Chain Amino Acids ratios, arginine, glutamine, and omega-3 fatty acids. Furthermore, a marked predominance of FSMPs with a high osmolarity (85.7%), sweet taste (72%), and only animal protein content (79.5%) was observed. Cost analysis of FSMPs revealed a mean cost of EUR 5.35/portion. Products were mostly adequate for cancer, neurodegenerative diseases, diabetes, inflammatory bowel disease, end-stage kidney disease, dysphagiam and chronic obstructive pulmonary disease. However, gaps have been found for sarcopenia and abdominal surgery. CONCLUSION In light of the current market landscape, there is a need for a comprehensive regulation that indicates the optimal composition of FSMPs and the production of such products to tackle disease-related malnutrition.
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Affiliation(s)
- Nagaia Madini
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Vincenti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Alice Beretta
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Sara Santero
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Giulia Viroli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Clinical Nutrition Unit, ICS Maugeri IRCCS, 27100 Pavia, Italy
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Zhang G, Zhao B, Deng T, He X, Chen Y, Zhong C, Chen J. Impact of perioperative immunonutrition on postoperative outcomes in pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. BMC Gastroenterol 2024; 24:412. [PMID: 39550568 PMCID: PMC11569618 DOI: 10.1186/s12876-024-03510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 11/12/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate the impact of perioperative immunonutrition on postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD). METHODS Conducted a comprehensive search in PubMed, Embase, Cochrane Library, Medline, and Web of Science databases to identify all randomized controlled trials (RCTs) on the topic of immunonutrition and PD. Subsequently screened literature, extracted data, and assessed the risk of bias in the included studies, and finally conducted a meta-analysis using RevMan 5.3 software. RESULTS The analysis included a total of 10 RCTs with 574 patients, among whom 288 were in the immunonutrition group and 283 in the control group. The meta-analysis revealed a significantly lower incidence of postoperative infection-related complications (OR = 0.45; 95% CI: 0.27-0.74; P = 0.002) and severe postoperative complications (OR = 0.61; 95% CI: 0.38-0.98; P = 0.04) in the immunonutrition group compared to the control group. Additionally, patients in the immunonutrition group had a significantly shorter length of hospital stay (MD= -1.87; 95%CI -3.29 - -0.44; P = 0.01). However, the analysis revealed no statistically significant difference in the overall complication rate between the two groups (P = 0.67). Furthermore, the incidence of specific complications and perioperative mortality rates also did not demonstrate any statistically significant differences (all P > 0.05). CONCLUSIONS Perioperative immunonutrition in PD patients can reduce postoperative infection-related complications, but more high-quality RCTs are needed for further validation.
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Affiliation(s)
- Gaofeng Zhang
- Department of Center for Hepatobiliary-Pancreatic-Splenic Disease, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong, 643000, Sichuan Province, China
| | - Bing Zhao
- Department of Center for Hepatobiliary-Pancreatic-Splenic Disease, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong, 643000, Sichuan Province, China
| | - Tengang Deng
- Department of Center for Hepatobiliary-Pancreatic-Splenic Disease, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong, 643000, Sichuan Province, China
| | - Xiaofei He
- Department of Center for Hepatobiliary-Pancreatic-Splenic Disease, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong, 643000, Sichuan Province, China
| | - Yongpin Chen
- Department of Center for Hepatobiliary-Pancreatic-Splenic Disease, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong, 643000, Sichuan Province, China
| | - Changtao Zhong
- Department of Center for Hepatobiliary-Pancreatic-Splenic Disease, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong, 643000, Sichuan Province, China
| | - Jie Chen
- Department of Center for Hepatobiliary-Pancreatic-Splenic Disease, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong, 643000, Sichuan Province, China.
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Bezu L, Akçal Öksüz D, Bell M, Buggy D, Diaz-Cambronero O, Enlund M, Forget P, Gupta A, Hollmann MW, Ionescu D, Kirac I, Ma D, Mokini Z, Piegeler T, Pranzitelli G, Smith L, The EuroPeriscope Group. Perioperative Immunosuppressive Factors during Cancer Surgery: An Updated Review. Cancers (Basel) 2024; 16:2304. [PMID: 39001366 PMCID: PMC11240822 DOI: 10.3390/cancers16132304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion. Thus, the perioperative period plays a key role in determining oncological outcomes and represents a short phase to circumvent anesthetic and surgical deleterious factors by supporting the immune system through the use of synergistic pharmacological and non-pharmacological approaches. In line with this, accumulating studies indicate that anesthetic agents could drive both protumor or antitumor signaling pathways during or after cancer surgery. While preclinical investigations focusing on anesthetics' impact on the behavior of cancer cells are quite convincing, limited clinical trials studying the consequences on survival and recurrences remain inconclusive. Herein, we highlight the main factors occurring during the perioperative period of cancer surgery and their potential impact on immunomodulation and cancer progression. We also discuss patient management prior to and during surgery, taking into consideration the latest advances in the literature.
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Affiliation(s)
- Lucillia Bezu
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Département d'Anesthésie, Chirurgie et Interventionnel, Gustave Roussy, 94805 Villejuif, France
- U1138 Metabolism, Cancer and Immunity, Gustave Roussy, 94805 Villejuif, France
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Dilara Akçal Öksüz
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Clinic for Anesthesiology, Intensive Care, Emergency Medicine, Pain Therapy and Palliative Medicine, Marienhaus Klinikum Hetzelstift, 67434 Neustadt an der Weinstrasse, Germany
- ESAIC Mentorship Program, BE-1000 Brussels, Belgium
| | - Max Bell
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Solna, 17176 Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institute, 17176 Stockholm, Sweden
| | - Donal Buggy
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Division of Anaesthesiology, Mater Misericordiae University Hospital, D07 WKW8 Dublin, Ireland
- School of Medicine, University College, D04 V1W8 Dublin, Ireland
| | - Oscar Diaz-Cambronero
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain
- Perioperative Medicine Research, Health Research Institute Hospital la Fe, 46026 Valencia, Spain
- Faculty of Medicine, Department of Surgery, University of Valencia, 46010 Valencia, Spain
| | - Mats Enlund
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Center for Clinical Research, Uppsala University, SE-72189 Västerås, Sweden
- Department of Anesthesia & Intensive Care, Västmanland Hospital, SE-72189 Västerås, Sweden
| | - Patrice Forget
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZN, UK
- Department of Anaesthesia, NHS Grampian, University of Aberdeen, Aberdeen AB25 2ZN, UK
- Pain and Opioids after Surgery (PANDOS) ESAIC Research Group, European Society of Anaesthesiology and Intensive Care, 1000 Brussels, Belgium
- IMAGINE UR UM 103, Anesthesia Critical Care, Emergency and Pain Medicine Division, Nîmes University Hospital, Montpellier University, 30900 Nîmes, France
| | - Anil Gupta
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Physiology and Pharmacology, Karolinska Institute, 17176 Stockholm, Sweden
| | - Markus W Hollmann
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Anesthesiology, Amsterdam UMC, 1100 DD Amsterdam, The Netherlands
| | - Daniela Ionescu
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy "Iuliu Hatieganu", 400012 Cluj-Napoca, Romania
- Outcome Research Consortium, Cleveland, OH 44195, USA
| | - Iva Kirac
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Genetic Counselling Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Daqing Ma
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London SW10 9NH, UK
- Department of Anesthesiology, Perioperative and Systems Medicine Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Zhirajr Mokini
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- ESAIC Mentorship Program, BE-1000 Brussels, Belgium
- Clinique du Pays de Seine, 77590 Bois le Roi, France
| | - Tobias Piegeler
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Anesthesiology and Intensive Care, University of Leipzig Medical Center, 04275 Leipzig, Germany
| | - Giuseppe Pranzitelli
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Anesthesiology and Intensive Care, San Timoteo Hospital, 86039 Termoli, Italy
| | - Laura Smith
- EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium
- Department of Anaesthesia, NHS Grampian, University of Aberdeen, Aberdeen AB25 2ZN, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZN, UK
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Xiao X, Luo S, Huang J, Wan B, Bi N, Wang J. Synergistic effects of Ω-3 polyunsaturated fatty acid supplementation and programmed cell death protein 1 blockade on tumor growth and immune modulation in a xenograft model of esophageal cancer. Clin Nutr ESPEN 2024; 61:308-315. [PMID: 38777449 DOI: 10.1016/j.clnesp.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/16/2024] [Accepted: 03/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Esophageal cancer, especially esophageal squamous cell carcinoma (ESCC), remains a significant global health challenge with limited survival rates. This study aimed to elucidate the combined effects of immune-modulating nutrition (IMN) with Ω-3 polyunsaturated fatty acid (PUFA) supplementation and anti-programmed cell death protein 1 (PD-1) treatment on tumor growth and immune responses in a xenograft model of ESCC. METHODS A total of 36 C57BL/6 mice were used to construct a xenograft model using the mouse esophageal cancer cell line AKR. Mice were subjected to treatment with anti- PD-1 antibody combined with either Ω-3 PUFA-rich or Ω-3 PUFA-deficient nutrition. Tumor growth, immune markers, cytokine profiles, and metabolic changes were evaluated. RESULTS The combination of anti-PD-1 and Ω-3 PUFA supplementation significantly inhibited tumor growth more effectively than anti-PD-1 treatment alone. Enhanced expression of immune markers PD-L1 and CD3 was observed in Ω-3 PUFA-fed mice. Additionally, compared with anti-PD-1 therapy and anti-PD-1 plus Ω-3 PUFA-deficient nutrition, Ω-3 PUFAs intensified alterations in key chemokines and cytokines, including elevated IL-12, IFN-γ, and GM-CSF levels, and reduced CXCL12 levels. However, Ω-3 PUFAs did not significantly alter the glycolysis and tryptophan metabolic program induced by anti-PD-1. CONCLUSION Our findings indicated the potential synergetic therapeutic benefits of combining anti-PD-1 treatment with Ω-3 PUFA supplementation in ESCC, which offered promising avenue for further research.
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Affiliation(s)
- Xi Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China; Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China
| | - Shihong Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Jianbing Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Bao Wan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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12
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Villar-Taibo R, Vidal-Casariego A, Santamaría-Nieto A, Cantón-Blanco A, Crujeiras AB, Lugo Rodríguez G, Rodríguez-Carnero G, Pita Gutiérrez F, Fernández Pombo A, Díaz-López E, Román Eyo A, Rodríguez Lavandeira U, Pena-Dubra A, Martínez-Olmos MÁ. Efficacy of a new immunonutrition formula with extra virgin olive oil in the reduction of complications in surgeries of upper digestive tract tumors. Front Nutr 2024; 11:1384145. [PMID: 38863591 PMCID: PMC11165349 DOI: 10.3389/fnut.2024.1384145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Background To demonstrate whether a nutritional supplement enriched with arginine, nucleotides, omega-3 fatty acids, and extra virgin olive oil reduces postoperative complications in patients with tumors in the upper digestive tract. Methods A randomized, controlled, double-blind, multicenter clinical trial, in which a new immunomodulatory formula with extra virgin olive oil was compared with a standard isoprotein and isoenergetic formula. Patients with gastric, esophageal or biliopancreatic tumors were recruited to receive two units of immunomodulatory formula or control, 5 days before the surgical intervention. Results A total of 119 patients were recruited. There was a significant reduction in the number of reinterventions (7.7 vs. 20.4%; p = 0.044) in the intervention group. There was a significant reduction in the development of fistulas in patients with phase angles >5.7°. Also, there were fewer readmissions after biliopancreatic surgeries (0.0 vs. 100%; p = 0.014). The length of hospital stay was similar between groups; however, with the immunomodulatory formula, the patients exhibited greater phase angle at the end of follow-up. Conclusion The immunomodulatory formula with extra virgin olive oil administered 5 days before surgery for stomach, esophageal and biliopancreatic tumors improved cellular health and reduced postoperative complications.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT04027088].
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Affiliation(s)
- Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Alfonso Vidal-Casariego
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Alicia Santamaría-Nieto
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Cantón-Blanco
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Molecular Endocrinology, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Ana B. Crujeiras
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- CIBER de Fisiopatología de La Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Gloria Lugo Rodríguez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Gemma Rodríguez-Carnero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Molecular Endocrinology, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- CIBER de Fisiopatología de La Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Pita Gutiérrez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Antía Fernández Pombo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Molecular Endocrinology, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Everardo Díaz-López
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Andrea Román Eyo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Uxía Rodríguez Lavandeira
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Alberto Pena-Dubra
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Miguel Ángel Martínez-Olmos
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Molecular Endocrinology, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- CIBER de Fisiopatología de La Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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13
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Gianotti L, Nespoli L, Sandini M. Pharmaconutrition: Which substrates? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106798. [PMID: 36526494 DOI: 10.1016/j.ejso.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
With the term "pharmaconutrition" or "immunonutrition" is intended the use of specific nutritional substrates having the ability of modulating specific mechanisms involved in several immune and inflammatory pathways. To achieve these goals, these substrates have to be administered with over physiologic dose. Glutamine and omega-3 polyunsaturated fatty acids, used as single substrate, did not show clear clinical advantages on solid endpoints such as postoperative complications. Despite several multiple substrate enteral feeds are available on the market, very few of them have been tested in randomized clinical trial to prove efficacy. The most extensive investigated formulation is a combination of arginine, omega-3 fatty acids, ribonucleic acid with or without glutamine. Several meta-analyses of randomized clinical trials have been conducted to compare the effects of enteral immunonutrition with control diets on post-surgical morbidity. The results consistently showed that the use of enteral multiple substrate formulas significantly reduced infectious complications and duration of hospitalization. In a more contemporary view, pharmaconutrition should be tested more accurately in the contest of enhanced recovery programs, during neoadjuvant chemotherapy, and in the prehabilitation setting.
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Affiliation(s)
- Luca Gianotti
- School of Medicine and Surgery, Milano-Bicocca University, Department of Surgery, IRCCS San Gerardo Hospital, Monza, Italy.
| | - Luca Nespoli
- School of Medicine and Surgery, Milano-Bicocca University, Department of Surgery, IRCCS San Gerardo Hospital, Monza, Italy
| | - Marta Sandini
- Surgical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Yu J, Yuan A, Liu Q, Wang W, Sun Y, Li Z, Meng C, Zhou Y, Cao S. Effect of preoperative immunonutrition on postoperative short-term clinical outcomes in patients with gastric cancer cachexia: a prospective randomized controlled trial. World J Surg Oncol 2024; 22:101. [PMID: 38632641 PMCID: PMC11022452 DOI: 10.1186/s12957-024-03348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/24/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Although current guidelines(ESPEN guideline: Clinical nutrition in surgery and other guidelines) recommend preoperative immunonutrition for cachectic gastric cancer patients, the strength of the recommendation is weak, and the level of evidence is low. The benefits of preoperative immunonutrition still remain controversial. PATIENTS AND METHODS 112 patients with gastric cancer cachexia were enrolled in the study and randomly assigned in a 1:1 ratio to receive either preoperative enteral immunonutrition support (IN, n = 56) or standard enteral nutrition support (SEN, n = 56). The primary endpoint was the incidence of infectious complications, and the secondary endpoints included the nutritional indicators, inflammatory markers, immune parameters, postoperative recovery and complications and gastrointestinal intolerance reactions. RESULTS The incidence of postoperative infectious complications(P = 0.040) and overall complications (P = 0.049)was significantly lower in the IN group compared to the SEN group. In terms of laboratory inflammatory indexes, patients in the IN group demonstrated significantly lower levels of white blood cells (WBC), C-reactive protein (CRP), and interleukin-6 (IL-6), as well as higher levels of lymphocytes (LYMPH) and immunoglobulin A (IgA), compared to patients in the SEN group, with statistically significant differences. In terms of clinical outcomes, the IN group had a shorter duration of antibiotic use (P = 0.048), shorter hospital stay (P = 0.018), and lower total hospital costs (P = 0.034) compared to the SEN group. The IN group also experienced significantly less weight loss after surgery (P = 0.043). CONCLUSION Preoperative administration of immunonutrition formula has a positive impact on the incidence of infectious complications in patients with gastric cancer cachexia after surgery. It improves patients' inflammatory and immune status, shortens hospital stays, and reduces healthcare costs. Preoperative use of immunonutrition may contribute to the improvement of prognosis in this high-risk population.
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Affiliation(s)
- Junjian Yu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Antai Yuan
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Qi Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Yuqi Sun
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Zequn Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Cheng Meng
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China.
| | - Shougen Cao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China.
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Boccardi V, Marano L. Improving geriatric outcomes through nutritional and immunonutritional strategies: Focus on surgical setting by a comprehensive evidence review. Ageing Res Rev 2024; 96:102272. [PMID: 38492809 DOI: 10.1016/j.arr.2024.102272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
The aging population worldwide has led to an increased request for surgical interventions in older, geriatric, and frail patients. However, all the physiological changes related to aging are associated with many challenges in the perioperative period, strongly impacting surgical outcomes. Nutritional status plays a pivotal role in determining the resilience of older adults to surgical stress and their ability to recover postoperatively. It is well known that malnutrition, a prevalent concern in geriatrics, is linked to increased adverse outcomes, including morbidity and mortality. Recognizing the significance of preoperative nutritional screening, assessment, diagnosis, intervention, and monitoring is essential for optimizing surgical outcomes. In this context, immunonutrition, which involves the supplementation of specific nutrients to modulate immune responses, emerges as a promising strategy to mitigate the increased inflammatory response observed in geriatric surgical patients. This study reviews current literature on the impact of nutrition and immunonutrition on surgical outcomes in geriatrics, highlighting the potential benefits in terms of reduced complications, enhanced wound healing, and shortened hospital stays. Recognizing and addressing the specific nutritional needs of older persons undergoing surgery is essential for promoting successful surgical outcomes and improving overall quality of life in this vulnerable population.
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Affiliation(s)
- Virginia Boccardi
- Section of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli 1, Perugia 06132, Italy.
| | - Luigi Marano
- Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych, 2 Lotnicza Street, Elbląg 82-300, Poland; Department of General Surgery and Surgical Oncology, "Saint Wojciech" Hospital, "Nicolaus Copernicus" Health Center, Jana Pawła II 50, Gdańsk 80-462, Poland
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Abenavoli L, Scarpellini E, Paravati MR, Scarlata GGM, Boccuto L, Tilocca B, Roncada P, Luzza F. Gut Microbiota and Critically Ill Patients: Immunity and Its Modulation via Probiotics and Immunonutrition. Nutrients 2023; 15:3569. [PMID: 37630759 PMCID: PMC10459644 DOI: 10.3390/nu15163569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Critically ill patients have a hyper-inflammatory response against various offending injuries that can result in tissue damage, organ failure, and fatal prognosis. The origin of this detrimental, uncontrolled inflammatory cascade can be found also within our gut. In detail, one of the main actors is our gut microbiota with its imbalance, namely gut dysbiosis: learning about the microbiota's dysfunction and pathophysiology in the frame of critical patients is of crucial and emerging importance in the management of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Multiple pieces of evidence indicate that the bacteria that populate our gut efficiently modulate the immune response. Treatment and pretreatment with probiotics have shown promising preliminary results to attenuate systemic inflammation, especially in postoperative infections and ventilation performance. Finally, it is emerging how immunonutrition may exert a possible impact on the health status of patients in intensive care. Thus, this manuscript reviews evidence from the literature on gut microbiota composition, its derangement in critically ill patients, its pathophysiological role, and the described and emerging opportunities arising from its modulation.
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Affiliation(s)
- Ludovico Abenavoli
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.P.); (G.G.M.S.); (B.T.); (P.R.); (F.L.)
| | - Emidio Scarpellini
- Translationeel Onderzoek van Gastro-Enterologische Aandoeningen (T.A.R.G.I.D.), Gasthuisberg University 11 Hospital, KU Leuven, Herestraat 49, 3000 Leuven, Belgium;
| | - Maria Rosaria Paravati
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.P.); (G.G.M.S.); (B.T.); (P.R.); (F.L.)
| | - Giuseppe Guido Maria Scarlata
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.P.); (G.G.M.S.); (B.T.); (P.R.); (F.L.)
| | - Luigi Boccuto
- School of Nursing, Healthcare Genetics Program, Clemson University, Clemson, SC 29634, USA;
- School of Health Research, Clemson University, Clemson, SC 29634, USA
| | - Bruno Tilocca
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.P.); (G.G.M.S.); (B.T.); (P.R.); (F.L.)
| | - Paola Roncada
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.P.); (G.G.M.S.); (B.T.); (P.R.); (F.L.)
| | - Francesco Luzza
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.P.); (G.G.M.S.); (B.T.); (P.R.); (F.L.)
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17
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Yoon SL, Grundmann O. Relevance of Dietary Supplement Use in Gastrointestinal-Cancer-Associated Cachexia. Nutrients 2023; 15:3391. [PMID: 37571328 PMCID: PMC10421404 DOI: 10.3390/nu15153391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Cancer cachexia is a multi-organ syndrome with unintentional weight loss, sarcopenia, and systemic inflammation. Gastrointestinal (GI) cancer patients are more susceptible to cachexia development due to impaired nutrient absorption and digestion. Given the widespread availability and relatively low cost of dietary supplements, we examined the evidence and effects of fish oil (omega-3 fatty acids), melatonin, probiotics, and green tea for managing symptoms of GI cancer cachexia. A literature review of four specific supplements was conducted using PubMed, Google Scholar, and CINAHL without a date restriction. Of 4621 available literature references, 26 articles were eligible for review. Fish oil decreased C-reactive protein and maintained CD4+ cell count, while melatonin indicated inconsistent findings on managing cachexia, but was well-tolerated. Probiotics decreased serum pro-inflammatory biomarkers and increased the tolerability of chemotherapy by reducing side effects. Green tea preparations and extracts showed a decreased risk of developing various cancers and did not impact tumor growth, survival, or adverse effects. Among these four supplements, probiotics are most promising for further research in preventing systemic inflammation and maintaining adequate absorption of nutrients to prevent the progression of cancer cachexia. Supplements may benefit treatment outcomes in cancer cachexia without side effects while supporting nutritional and therapeutic needs.
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Affiliation(s)
- Saunjoo L. Yoon
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL 32610, USA;
| | - Oliver Grundmann
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL 32610, USA;
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
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Do Woong Choi J, Kwik C, Vivekanandamoorthy N, Shanmugalingam A, Allan L, Gavegan F, Shedden K, Peters A, Khoury TE, Pathmanathan N, Toh JWT. Is preoperative hypoalbuminemia or hypoproteinemia a reliable marker for anastomotic leakage risk in patients undergoing elective colorectal surgery in an enhanced recovery after surgery (ERAS) program? Int J Colorectal Dis 2023; 38:152. [PMID: 37256440 PMCID: PMC10232607 DOI: 10.1007/s00384-023-04450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Preoperative hypoalbuminemia has traditionally been used as a marker of nutritional status and is considered a significant risk factor for anastomotic leak (AL). METHODS The Westmead Enhanced Recovery After Surgery (WERAS) prospectively collected database, consisting of 361 patients who underwent colorectal surgery with primary anastomosis, was interrogated. Preoperative serum albumin and protein levels (measured within 1 week of surgery) were plotted on receiver operating characteristic curves (ROC curves) and statistically analyzed for cutoff values, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV). RESULTS The incidence of AL was 4.4% (16/361). Overall mortality was 1.4% (5/361), 6.3% (1/16) in the AL group, and 1.2% (4/345) in the no AL group. The median preoperative albumin and protein level in the AL group were 39 g/L and 75 g/L, respectively. The median preoperative albumin and protein level in the no AL group were 38 g/L and 74 g/L, respectively. The Mann-Whitney U test showed no statistically significant difference in albumin levels (p = 0.4457) nor protein levels (p = 0.6245) in the AL and no AL groups. ROC curves demonstrated that preoperative albumin and protein levels were not good predictors of anastomotic leak. Cutoff values for albumin (38 g/L) and protein (75 g/L) both had poor PPV for AL (4.8% and 3.8% respectively). CONCLUSION In patients undergoing elective colorectal surgery as part of an ERAS program, preoperative serum albumin and protein levels are not reliable in predicting AL. This may be because of nutritional supplementation provided as part of an ERAS program may correct nutritional deficits to protect against AL or that low albumin/protein is not as robust a marker of AL as previously reported.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Charlotte Kwik
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
| | - Nurojan Vivekanandamoorthy
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
| | - Aswin Shanmugalingam
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
| | - Lachlan Allan
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
| | - Fiona Gavegan
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
| | - Karen Shedden
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
| | - Ashleigh Peters
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
| | - Toufic El Khoury
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Nimalan Pathmanathan
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James Wei Tatt Toh
- Department of Colorectal Surgery, Westmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, Sydney, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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19
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Chervu N, Mabeza RM, Kronen E, Sakowitz S, Bakhtiyar SS, Hadaya J, Benharash P. Contemporary association of preoperative malnutrition and outcomes of hiatal hernia repairs in the United States. Surgery 2023:S0039-6060(23)00188-5. [PMID: 37217387 DOI: 10.1016/j.surg.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Hypoalbuminemia has been used as a surrogate for malnutrition and is associated with worse postoperative outcomes across major operations. Because patients with hiatal hernia often have inadequate caloric intake, we examined the association of serum albumin levels with outcomes after hiatal hernia repair. METHODS Adults undergoing elective and non-elective hiatal hernia repair via any approach were tabulated from the 2012 to 2019 National Surgical Quality Improvement Program. Patients were stratified into the Hypoalbuminemia cohort if serum albumin <3.5 mg/dL using restricted cubic spline analysis. Major adverse events were defined as a composite of all-cause mortality and major complications per the American College of Surgeons National Surgical Quality Improvement Program risk calculator. Entropy balancing was used to adjust for intergroup differences. Multivariable regression models were then constructed to assess the association of preoperative albumin with major adverse events, postoperative length of stay, and 30-day readmission. RESULTS Of 23,103 patients, 11.7% comprised the Hypoalbuminemia cohort. The Hypoalbuminemia group was older, less commonly of White race, and less likely to have an independent functional status than others. They were also more likely to undergo inpatient, non-elective surgery via laparotomy. After entropy balancing and adjustment, hypoalbuminemia remained associated with increased odds of major adverse events and multiple complications and longer adjusted postoperative length of stay. There was no significant difference in adjusted odds of readmission. CONCLUSION We used a quantitative methodology to establish a serum albumin threshold of 3.5 mg/dL associated with increased adjusted odds of major adverse events, increased postoperative length of stay, and postoperative complications after hiatal hernia repair. These results may guide preoperative nutrition supplementation.
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Affiliation(s)
- Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Russyan Mark Mabeza
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; Department of Surgery, University of Colorado, Aurora, CO
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA.
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20
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Noorian S, Kwaan MR, Jaffe N, Yaceczko SD, Chau LW. Perioperative nutrition for gastrointestinal surgery: On the cutting edge. Nutr Clin Pract 2023; 38:539-556. [PMID: 36847684 DOI: 10.1002/ncp.10970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 03/01/2023] Open
Abstract
Evidence on perioperative nutrition interventions in gastrointestinal surgery is rapidly evolving. We conducted a narrative review of various aspects of nutrition support, including formula choice and route of administration, as well as duration and timing of nutrition support therapy. Studies have demonstrated that nutrition support is associated with improved clinical outcomes in malnourished patients and those at nutrition risk, emphasizing the importance of nutrition assessment, for which several validated nutrition risk assessment tools exist. The assessment of serum albumin levels has fallen out of favor, as it is an unreliable marker of nutrition status, whereas imaging evidence of sarcopenia has prognostic value and may emerge as a standard component of nutrition assessment. Preoperatively, evidence supports limiting fasting to reduce insulin resistance and improve oral tolerance. Benefits to preoperative carbohydrate loading remain unclear, whereas literature suggests preoperative parenteral nutrition (PN) may reduce postoperative complications in high-risk patients with malnutrition or sarcopenia. Postoperatively, early oral feeding is safe with benefits in time to return of bowel function and reduced hospital stay. There is a signal for potential benefit to early postoperative PN in critically ill patients, though evidence is sparse. There has also been a recent emergence in randomized studies evaluating the use of ω-3 fatty acids, amino acids, and immunonutrition. Meta-analyses have reported favorable outcomes for these supplements, though individual studies are small and with significant methodological limitations and risk of bias, emphasizing the need for high-quality randomized studies to guide clinical practice.
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Affiliation(s)
- Shaya Noorian
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Mary R Kwaan
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Nancee Jaffe
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Lydia W Chau
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
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21
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Khan A, Wong J, Riedel B, Laing E, Beaumont A, Kong J, Warrier S, Heriot A. The Impact of Peri-operative Enteral Immunonutrition on Post-operative Complications in Gastrointestinal Cancer Surgery: A Meta-Analysis. Ann Surg Oncol 2023; 30:3619-3631. [PMID: 36820938 DOI: 10.1245/s10434-023-13265-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Immunonutrition (IMN) in gastrointestinal (GI) cancer surgery remains under-utilised and contentious. Despite previous meta-analysis reporting benefit, most recent randomised control trials (RCTs) have failed to demonstrate this and have recommended against its routine use. A contemporary meta-analysis may contribute to the recommendations for immunonutrition use and help select which patients may benefit. The objective of this study was to review IMN and its impact on post-operative outcomes in GI cancer surgery, exploring its role in both malnourished and non-malnourished populations, the optimal dose to use, cancer type of patients using IMN and the timing of IMN relative to the peri-operative period. PATIENTS AND METHODS The EMBASE and Medline databases were searched from 2000 to 2022 for RCTs evaluating IMN in adults undergoing GI cancer surgery. RESULTS Thirty-seven studies were included (22 pre-operative IMN studies, 11 peri-operative IMN trials and 9 post-operative IMN trials; 4 trials had multiple IMN protocols) that reported on 3793 patients. The main outcome of post-operative infectious complications was reduced with IMN [odds ratio (OR) 0.58, 95% confidence interval (CI) 0.47-0.72]. This association was significant in subgroup analysis only with pre-operative and peri-operative administration and in trials including upper GI cancers, colorectal cancer and 'mixed GI' cancer populations, and significance was independent of nutritional status. IMN in pooled analysis reduced surgical site infection (SSI) (OR 0.65, 95% CI 0.52-0.81), anastomotic leak (OR 0.67, 95% CI 0.47-0.93) and length of stay (LOS) by 1.94 days (95% CI - 3 to - 0.87). CONCLUSION Immunonutrition was associated with reduced post-operative complications. Peri-operative administration may be the preferred strategy in reducing infectious complications, anastomotic leak, SSI and LOS.
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Affiliation(s)
- Ayman Khan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
| | - Jean Wong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Bernhard Riedel
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Erin Laing
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Anna Beaumont
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Satish Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
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22
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Bigagli E, D’Ambrosio M, Cinci L, Fiorindi C, Agostiniani S, Bruscoli E, Nannoni A, Lodovici M, Scaringi S, Giudici F, Luceri C. Impact of Preoperative Immunonutrition on Oxidative Stress and Gut Barrier Function in Surgical Patients with Crohn's Disease. Nutrients 2023; 15:nu15040882. [PMID: 36839239 PMCID: PMC9960923 DOI: 10.3390/nu15040882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Several international guidelines recommend a peri-operative immunonutrition (IN) support for patients care in elective colorectal surgery, to reduce postoperative complications, particularly infections. In Crohn's patients, is also used to mitigate the severity of the disease. We performed a pilot study on 16 Crohn's patients undergoing intestinal surgery for active disease, not responsive to pharmacological treatment; half of them received an oral nutritional supplement enriched with immunonutrients (IN patients) for 7 days prior to surgery, in addition to normal food intake. Markers of oxidative stress (Advanced Glycated End-products (AGEs) and Advanced Oxidation Protein Products (AOPPs) were measured both in plasma and tissue samples wherein the Receptor for Advanced Glycation End products (RAGE) and Tight Junction Protein 1 (TJP1) gene expression were also determined. Plasma AGEs were significantly and positively correlated with tissue levels of AGEs (p = 0.0354) and AOPPs (p = 0.0043) while they were negatively correlated with TJP1 expression (p = 0.0159). The expression of RAGE was also negatively correlated with that of TJP1 gene (p = 0.0146). IN patients exhibited significantly lower AGEs plasma levels (p = 0.0321) and a higher mucosal TJP1 expression (p = 0.0182). No patient had postoperative complications and the length of hospital stay was similar in the two groups, but IN patients, showed a significantly shorter time to resume fluid and solid diet. These preliminary data suggest that IN might support patient's recovery by improving intestinal mucosa barrier function through the regulation of AGEs/RAGE signaling.
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Affiliation(s)
- Elisabetta Bigagli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, 50134 Firenze, Italy
| | - Mario D’Ambrosio
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, 50134 Firenze, Italy
| | - Lorenzo Cinci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, 50134 Firenze, Italy
| | - Camilla Fiorindi
- Department of Health Science, University of Firenze, 50134 Firenze, Italy
| | - Sara Agostiniani
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, 50134 Firenze, Italy
| | - Elisa Bruscoli
- Department of Health Science, University of Firenze, 50134 Firenze, Italy
| | - Anita Nannoni
- Department of Health Science, University of Firenze, 50134 Firenze, Italy
| | - Maura Lodovici
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, 50134 Firenze, Italy
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
- Correspondence: (F.G.); (C.L.)
| | - Cristina Luceri
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, 50134 Firenze, Italy
- Correspondence: (F.G.); (C.L.)
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23
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Gaspar-Figueiredo S, Labgaa I, Demartines N, Schäfer M, Joliat GR. Assessment of the Predictive Value of Preoperative Serum Albumin and Postoperative Albumin Drop (ΔAlb) for Complications after Pancreas Surgery: A Single-Center Cross-Sectional Study. J Clin Med 2023; 12:jcm12030972. [PMID: 36769619 PMCID: PMC9917642 DOI: 10.3390/jcm12030972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Serum albumin has been shown to be predictive of complications after various gastrointestinal operations. The present study aimed to assess whether preoperative serum albumin and serum albumin drop on postoperative day 1 are associated with postoperative complications after pancreatic surgery. METHODS A single-center cross-sectional study was performed. All patients who underwent pancreatectomy between January 2010 and June 2019 and had preoperative serum albumin value and serum albumin value on postoperative day 1 were included. ΔAlb was defined as the difference between preoperative serum albumin and serum albumin on postoperative day 1. Binary logistic regressions were performed to determine independent predictors of postoperative complications. RESULTS A total of 185 patients were included. Pancreatoduodenectomies were performed in 133 cases, left pancreatectomies in 36, and other pancreas operations in 16. The preoperative serum albumin value was found to be an independent predictor of complications (OR 0.9, 95%CI 0.9-1.0, p = 0.041), whereas ΔAlb was not significantly associated with postoperative complications (OR 1.0, 95%CI 0.9-1.1, p = 0.787). The threshold of 44.5 g/L for preoperative albumin level was found to have the highest combined sensitivity and specificity based on the maximum Youden index. Patients with preoperative albumin < 44.5 g/L had a higher incidence of postoperative complications and higher median comprehensive complication index than patients with preoperative albumin ≥ 44.5 g/L. CONCLUSIONS This study highlighted that preoperative serum albumin is an independent predictor of postoperative complications after pancreas surgery.
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Affiliation(s)
- Sérgio Gaspar-Figueiredo
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Ismail Labgaa
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Correspondence: (N.D.); (G.-R.J.); Tel.: +41-21-314-24-00 (N.D.); +41-79-556-42-93 (G.-R.J.); Fax: +41-21-314-23-11 (N.D. & G.-R.J.)
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
- Correspondence: (N.D.); (G.-R.J.); Tel.: +41-21-314-24-00 (N.D.); +41-79-556-42-93 (G.-R.J.); Fax: +41-21-314-23-11 (N.D. & G.-R.J.)
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Ambrosio MR, Spagnoli L, Perotti B, Petrelli F, Caini S, Saieva C, Usai S, Bianchini M, Cavazzana A, Arganini M, Amorosi A. Paving the Path for Immune Enhancing Nutrition in Colon Cancer: Modulation of Tumor Microenvironment and Optimization of Outcomes and Costs. Cancers (Basel) 2023; 15:cancers15020437. [PMID: 36672387 PMCID: PMC9857076 DOI: 10.3390/cancers15020437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Published evidence suggests that immunonutrition has the potential to decrease postoperative complications and reduce length of stay in patients undergoing surgery for colorectal cancer. However, only a few studies have analyzed the effects of immunonutrition on tumor microenvironment and evaluated its prognostic impact. MATERIAL AND METHODS This is a single center retrospective study enrolling 50 patients undergoing elective surgery for colorectal cancer managed with immunonutrition and 50 patients managed with standard nutrition for comparison. Tumor microenvironment was analyzed before (on the biopsy at the time of diagnosis) and after (on the matched surgical specimen) administration of immunonutrition. Immune function related indicators, including cytotoxic T-lymphocytes, helper T-cells, antigen presenting cells, natural killer cells, T-exhausted lymphocytes, T-regulatory cells, M1 and M2 tumor associated macrophages and PD-L1 expression were assessed by immunohistochemistry. For both groups, clinicopathological data were collected and a 5-year follow-up was available. RESULTS We found that immunonutrition significantly activated the T-cell response against cancer, alter tumor microenvironment phenotype towards M2 polarization and inhibits the PD1/PD-L1 axis. A lower rate of postoperative complications and a shorter length of stay (p = 0.04) were observed in the immune nutrition group. Compared to standard nutrition group, patients managed wit immune nutrition showed a higher 5-year overall survival (p = 0.001). Finally, immune nutrition allowed to reduce the hospital care costs. CONCLUSIONS Immunonutrition modulates tumor microenvironment by improving immune function and could prolong survival in patients undergoing elective surgery for colorectal cancer. Further studies are needed to optimize IN protocols and confirm their prognostic impact.
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Affiliation(s)
| | - Luigi Spagnoli
- Pathology Unit, Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| | - Bruno Perotti
- Surgery Unit, Ospedale Unico Versilia, Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| | | | - Saverio Caini
- Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research and Clinical Network (ISPRO), 50134 Florence, Italy
| | - Calogero Saieva
- Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research and Clinical Network (ISPRO), 50134 Florence, Italy
| | - Sofia Usai
- Department of Surgical Science, Sapienza University of Rome, 00100 Rome, Italy
| | - Matteo Bianchini
- Surgery Unit, Ospedale Unico Versilia, Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| | - Andrea Cavazzana
- Pathology Unit, Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| | - Marco Arganini
- Surgery Unit, Ospedale Unico Versilia, Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| | - Andrea Amorosi
- Department of Health Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
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Franceschilli M, Siragusa L, Usai V, Dhimolea S, Pirozzi B, Sibio S, Di Carlo S. Immunonutrition reduces complications rate and length of stay after laparoscopic total gastrectomy: a single unit retrospective study. Discov Oncol 2022; 13:62. [PMID: 35816241 PMCID: PMC9273797 DOI: 10.1007/s12672-022-00490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Preoperative immunonutrition (IN) reduces the incidence of postoperative complications in malnourished patients undergoing upper gastrointestinal surgery. However, its effect in norm-nourished patients remains unclear. Furthermore, patients with gastric cancer undergoing laparoscopic total gastrectomy (LTG) are not routinely included in protocols of enhanced recovery after surgery (ERAS). OBJECTIVE The aim of this study was to investigate the effects of perioperative IN in patients undergoing laparoscopic total gastrectomy (LTG) within an established ERAS pathway. METHODS A comparative retrospective study of patients undergoing LTG, receiving an immune-enhancing feed plus maltodextrin load the day of surgery (Group A) versus patients who had the same operation but no IN nor fast track management (group B). RESULTS There were no significant differences in patient demographic characteristics between the two groups but the medium age of patients in group A was older. Thirty-days postoperative complications were respectively 8.7% in Group A and 33.3% in Group B (p 0.04). Mean and median LOS for Group A and B were also significantly different: 7.2 ± 4.4 vs 10.3 ± 5.4 and 7 vs 10 days respectively. CONCLUSION Preoperative IN associated with ERAS protocol in normo-nourished patient undergoing LTG seems to reduce postoperative complications. Reduction in LOS is possibly associated to the ERAS protocol. Clinical trial registration Clinical trials.gov: NCT05259488.
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Affiliation(s)
- Marzia Franceschilli
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.
| | - Leandro Siragusa
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Valeria Usai
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Brunella Pirozzi
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Simone Sibio
- Department of Surgery "Pietro Valdoni", University "Sapienza" of Rome, Viale del Policlinico, Rome, Italy
| | - Sara Di Carlo
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
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Tsuchiya N, Kunisaki C, Kondo H, Sato S, Sato K, Watanabe J, Takeda K, Kosaka T, Akiyama H, Endo I. Prognostic Factors Affecting Short- and Long-Term Outcomes of Gastrectomy for Gastric Cancer in Older Patients. Dig Surg 2022; 39:109-116. [PMID: 35439756 DOI: 10.1159/000524609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION The benefits of surgery in older patients with gastric cancer are controversial. This single-institution retrospective study in Japan aimed to evaluate the impact of gastrectomy in older patients with gastric cancer. METHODS A series of 234 patients aged ≥80 years with histologically confirmed gastric cancer had indications for surgical treatment at the Gastroenterological Center, Yokohama City University Medical Center, between April 2002 and December 2018. Patients who were lost to follow-up (n = 27), had tumors not eligible for surgery (n = 14), and could not achieve R0 resection (n = 7) were excluded from this retrospective study. The remaining 186 patients were included. Patient characteristics, intraoperative outcomes, postoperative complications, and long-term survival were evaluated. RESULTS The incidence of postoperative complications with Clavien-Dindo grade ≥ II was observed in 61 patients (32.8%). The 5-year relapse-free survival and overall survival (OS) rates were 84.2% and 63.4%, respectively. Multivariate analysis showed that geriatric nutritional risk index (<98) (odds ratio, 1.97; p = 0.047), neutrophil/lymphocyte ratio (>2.36) (odds ratio, 1.94; 95% confidence interval, 1.02-3.67; p = 0.043), and total gastrectomy (TG) (odds ratio, 1.97; p = 0.042) significantly predicted postoperative complications. Moreover, TG (hazard ratio, 1.91; p = 0.036) was an independent prognostic factor of OS. CONCLUSIONS Poor immunonutritional status and TG led to worse short-term outcomes. Moreover, TG was an independent prognostic factor of OS in older patients with gastric cancer. It is necessary to provide effective perioperative care, including nutritional support, to clarify whether short-term outcomes would be improved.
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Affiliation(s)
- Nobuhiro Tsuchiya
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan,
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroki Kondo
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Sho Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kei Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuhisa Takeda
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kosaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama-city University, Yokohama, Japan
| | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama-city University, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama-city University, Yokohama, Japan
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Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, González-Navarro I, Remón-Ruíz PJ, Pereira-Cunill JL, García-Luna PP. Perioperative Nutritional Support: A Review of Current Literature. Nutrients 2022; 14:1601. [PMID: 35458163 PMCID: PMC9030898 DOI: 10.3390/nu14081601] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/27/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
Since the beginning of the practice of surgery, the reduction of postoperative complications and early recovery have been two of the fundamental pillars that have driven the improvement of surgical techniques and perioperative management. Despite great advances in these fields, the rationalization of antibiotic prophylaxis, and other important innovations, postoperative recovery (especially in elderly patients, oncological pathology or digestive or head and neck surgery) is tortuous. This can be explained by several reasons, among which, malnutrition has a major role. Perioperative nutritional support, included within the ERAS (Enhanced Recovery After Surgery) protocol, has proven to be a main element and a critical step to achieve better surgical results. Starting with the preoperative nutritional assessment and treatment in elective surgery, we can improve nutritional status using oral supplements and immunomodulatory formulas. If we add early nutritional support in the postoperative scenario, we are able to significantly reduce infectious complications, need for intensive care unit (ICU) and hospital stay, costs, and mortality. Throughout this review, we will review the latest developments and the available literature.
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Affiliation(s)
| | | | | | | | | | - José Luís Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.J.M.-O.); (A.P.-G.); (P.S.-A.); (I.G.-N.); (P.J.R.-R.); (P.P.G.-L.)
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Brajcich BC, Stigall K, Walsh DS, Varghese TK, Barber AE, Kralovich KA, Wescott AB, Pockaj BA, Ko CY, Laronga C. Preoperative Nutritional Optimization of the Oncology Patient: A Scoping Review. J Am Coll Surg 2022; 234:384-394. [PMID: 35213503 DOI: 10.1097/xcs.0000000000000055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malnutrition is common among patients with cancer and is a known risk factor for poor postoperative outcomes; however, preoperative nutritional optimization guidelines are lacking in this high-risk population. The objective of this study was to review the evidence regarding preoperative nutritional optimization of patients undergoing general surgical operations for the treatment of cancer. METHODS A literature search was performed across the Ovid (MEDLINE), Cochrane Library (Wiley), Embase (Elsevier), CINAHL (EBSCOhost), and Web of Science (Clarivate) databases. Eligible studies included randomized clinical trials, observational studies, reviews, and meta-analyses published between 2010 and 2020. Included studies evaluated clinical outcomes after preoperative nutritional interventions among adult patients undergoing surgery for gastrointestinal cancer. Data extraction was performed using a template developed and tested by the study team. RESULTS A total of 5,505 publications were identified, of which 69 studies were included for data synthesis after screening and full text review. These studies evaluated preoperative nutritional counseling, protein-calorie supplementation, immunonutrition supplementation, and probiotic or symbiotic supplementation. CONCLUSIONS Preoperative nutritional counseling and immunonutrition supplementation should be considered for patients undergoing surgical treatment of gastrointestinal malignancy. For malnourished patients, protein-calorie supplementation should be considered, and for patients undergoing colorectal cancer surgery, probiotics or symbiotic supplementation should be considered.
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Affiliation(s)
- Brian C Brajcich
- From the Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Brajcich, Ko)
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, IL (Brajcich)
| | - Kyle Stigall
- San Antonio Military Medical Center, JBSA-Ft. Sam Houston, San Antonio, TX (Stigall)
| | - Danielle S Walsh
- Division of Pediatric Surgery, East Carolina University Brody School of Medicine, Greenville, NC (Walsh)
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT (Varghese)
| | - Annabel E Barber
- Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV (Barber)
| | - Kurt A Kralovich
- Department of Surgery, Henry Ford Health System, Detroit, MI (Kralovich)
| | - Annie B Wescott
- Northwestern University Feinberg School of Medicine, Chicago, IL (Wescott)
| | | | - Clifford Y Ko
- From the Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Brajcich, Ko)
- Department of Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA (Ko)
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK (Ko)
| | - Christine Laronga
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL (Laronga)
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29
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Umbrella review of the efficacy of perioperative immunonutrition in visceral surgery. Clin Nutr ESPEN 2022; 48:99-108. [DOI: 10.1016/j.clnesp.2022.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 02/06/2023]
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30
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Williams DGA, Wischmeyer PE. Nutrition Status Optimization for Improved Perioperative Outcomes. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-021-00504-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Shoji F, Kozuma Y, Toyokawa G, Yamazaki K, Takeo S. Impact of Preoperative Immunonutritional Support in Patients Undergoing Elective Thoracic Surgery. JMA J 2021; 4:387-396. [PMID: 34796293 PMCID: PMC8580703 DOI: 10.31662/jmaj.2021-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: Several immunonutritional supplements have recently been developed. However, improvements in preoperative immunonutritional conditions using these supplements have not been analyzed in patients undergoing thoracic surgery. Methods: This prospective, single-arm, single-institution pilot study involved patients planning to undergo thoracic surgery. Forty adults with a poor preoperative immunonutritional status were enrolled. The patients freely selected one of three oral immunonutritional supplements (IMPACTⓇ, MEINⓇ, or AboundⓇ) and started taking it on an outpatient basis from 7 to 14 days before thoracic surgery. The primary endpoint was the rate of improvement in three immunonutritional parameters on the hospitalization day: body mass index (BMI), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI). These improvement rates were compared with those of a matched historical control group. Results: The PNI and GNRI improvement rates were significantly higher in the immunonutritional support group than in the control group (PNI: 103.1% ± 0.6% vs. 98.9% ± 1.3%, p = 0.0391; GNRI: 101.7% ± 0.8% vs. 99.3% ± 0.8%, p = 0.0266), although there was no significant difference in the BMI improvement rate (101.0% ± 0.6% vs. 100.2% ± 0.7%, p = 0.3626). The PNI and GNRI improvement rates were significantly higher in the IMPACTⓇ support group than in the control group (PNI: 104.5% ± 2.4% vs. 98.9% ± 1.3%, p = 0.0212; GNRI: 101.6% ± 1.1% vs. 99.3% ± 0.8%, p = 0.0415). Conclusions: The present study revealed that short-term preoperative immunonutritional support can actually improve immunonutritional parameters immediately before surgery. In particular, preoperative immunonutritional support using IMPACTⓇ supplementation might be the most promising agent in patients with a poor immunonutritional condition undergoing elective thoracic surgery. Trial registration: University Hospital Medical Information Network 000035851
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Affiliation(s)
- Fumihiro Shoji
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Yuka Kozuma
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Gouji Toyokawa
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
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Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40:4745-4761. [PMID: 34242915 DOI: 10.1016/j.clnu.2021.03.031] [Citation(s) in RCA: 329] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.
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Affiliation(s)
- Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Marco Braga
- University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Franco Carli
- Department of Anesthesia of McGill University, School of Nutrition, Montreal General Hospital, Montreal, Canada
| | | | - Martin Hübner
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Lausanne, Lausanne, Switzerland
| | - Stanislaw Klek
- General Surgical Oncology Clinic, National Cancer Institute, Krakow, Poland
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Dan Waitzberg
- University of Sao Paulo Medical School, Ganep, Human Nutrition, Sao Paulo, Brazil
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Pierre Singer
- Institute for Nutrition Research, Rabin Medical Center, Beilison Hospital, Petah Tikva, Israel
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Suárez-Lledó A, Leiva-Badosa E, Llop-Talaveron JM, Fernández-Alvarez M, Farran-Teixidor L, Miró-Martín M, Virgili-Casas N, Creus-Costas G, Bas-Minguet J, Poyatos-Canton E, Navarro-Velazquez S, Badia-Tahull MB. Clinical, randomized, double blind clinical trial to study the effect of parenteral supplementation with fish oil emulsion in the nutritional support in esophagectomized patients. Medicine (Baltimore) 2021; 100:e26426. [PMID: 34160431 PMCID: PMC8238298 DOI: 10.1097/md.0000000000026426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Esophagectomy is a major surgery with a high degree of catabolic and post-surgical inflammatory response accompanied by high morbidity and significant mortality. Post-surgical nutritional support via enteral administration of ω-3 fatty acids has been seen to be effective although its bad tolerance. There are few clinical trials with parenteral ω-3 fatty acids in these patients. We propose to investigate the effect of combining a parenteral fish oil lipid emulsion with the standard enteral nutrition (EN) support. MATERIALS AND METHODS Prospective, single-center, randomized, double-blind study in esophagectomized patients, and treated after surgery with parenteral lipid emulsions of ω-3 fatty acids or a mixture of ω-6 long-chain triglycerides/short-chain triglycerides 50%. These emulsions will be added to the standard nutritional support in continuous infusion until 5 days of treatment have been completed. Patients will be randomized 1:1:1 in Group A receiving 0.4 g/kg/d of fish-oil lipid emulsion and 0.4 g/kg/d of a lipid emulsion mixture of ω-6 long-chain fatty acids (LCT) plus medium-chain fatty acids (MCT) (total dose of 0.8 g/kg/d of lipid emulsion); Group B receiving 0.8 g/kg/d of fish oil lipid emulsion and Group C receiving 0.8 g/kg/d of LCT/MCT emulsion.The main objective is to determine whether 5 days administration of intravenous ω-3 fatty acid lipid emulsion is effective in normalizing interleukin-6 levels compared with LCT/MCT emulsions, and whether a 0.8 g/kg/d dose is more effective than 0.4 g/kg/d. Secondary outcomes include other inflammatory markers such as C-reactive protein, tumor necrosis factor alpha and interleukin-10, and parameters of morbidity, safety, nutrition and mortality.Samples will be collected at the time when surgery is indicated and on days 0, 1, 3, 5 and 21 to determine inflammatory, nutritional, hepatic and safety parameters. In addition, clinical follow-up will be continued throughout the hospital admision and up to 1 year after surgery. DISCUSSION Studies of ω-3 fatty acids administered parenterally in esophagectomized patients are scarce. This study proposes to investigate the effect of combining fish-oil lipid emulsions administered parenterally with EN support. Potential benefits include fast incorporation of lipids to the cellular membranes and to the inflammatory cascade, and the use of only 1 pharmaconutrient. TRIAL REGISTRATION FAR-NP-2017-01 EudraCT number: 2016-004978-17.https://reec.aemps.es/reec/public/detail.html searching the EudraCT number. VERSION IDENTIFIER Version 2, 08/06/2017.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jordi Bas-Minguet
- Inmunology Laboratory, Bellvitge Hospital, University of Barcelona-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabet Poyatos-Canton
- Inmunology Laboratory, Bellvitge Hospital, University of Barcelona-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Navarro-Velazquez
- Inmunology Laboratory, Bellvitge Hospital, University of Barcelona-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
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Wong CS, Praseedom R, Liau SS. Perioperative immunonutrition in hepatectomy: A systematic review and meta-analysis. Ann Hepatobiliary Pancreat Surg 2020; 24:396-414. [PMID: 33234742 PMCID: PMC7691191 DOI: 10.14701/ahbps.2020.24.4.396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/30/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022] Open
Abstract
Backgrounds/Aims The role of immunonutrition (IMN) after liver resections or hepatectomies remains unclear and controversial. We undertook a systematic review to evaluate the effects of IMN on clinical outcomes of patients undergoing hepatectomy. Methods Main electronic databases were searched for randomised trials reported clinical outcomes or effects of IMN. The systematic review was conducted in accordance with the PRISMA guideline and meta-analysis was analysed using fixed or random-effects models. Results Eleven RCTs were identified. A total of 1084 patients (529 IMN and 555 Control) were included in the final pooled analysis. Of these patients, 43% (440/1016) underwent major hepatectomies and the majority are for hepatocellular carcinoma (90%, 956/1055) with Child-Pugh A disease (89%, 793/894). IMN significantly reduced post-operative wound infection (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.43 to 0.96; p=0.03). IMN also had a shorter hospital stay (MD -4.97 days, 95% CI -8.23 to -1.72; p=0.003). There was no statistically significant in other post-operative morbidities and mortality. Conclusions Wound infection rate was not significantly different between oral and parenteral IMN group. The length of hospital stay was significantly lower in parenteral IMN group than in oral IMN group. The mortality rates were not affected. Immunonutrition should be recommended routinely as part of the nutritional support in the Enhanced Recovery after Surgery (ERAS) protocol for hepatectomy.
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Affiliation(s)
- Chee Siong Wong
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,University of Edinburgh, Edinburgh, UK.,Royal College of Surgeons of Edinburgh, Edinburgh, UK
| | - Raaj Praseedom
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Siong-Seng Liau
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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35
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Comparison of Perioperative Standard and Immunomodulating Enteral Nutrition in Patients Received Major Abdominal Cancer Surgery: a Prospective, Randomized, Controlled Clinical Trial. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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36
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Knackstedt R, Oliver J, Gatherwright J. Evidence-Based Perioperative Nutrition Recommendations: Optimizing Results and Minimizing Risks. Plast Reconstr Surg 2020; 146:423-435. [PMID: 32740600 DOI: 10.1097/prs.0000000000007004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Plastic surgery patients span the nutritional spectrum from generally healthy, nutritionally competent patients to inherently catabolic, nutritionally deficient, and chronic wound patients. Therefore, plastic and reconstructive surgery affords the opportunity to investigate the impact of nutrition across a heterogeneous patient population following a wide variety of procedures. Although patients may be nutritionally deficient in certain vitamins warranting perioperative repletion, other supplements have the potential to benefit all patients, regardless of nutritional status. Despite these putative benefits, there is a dearth of information regarding nutritional optimization, with the limited, available literature focusing mostly on herbal supplements and their potential side effects. A significant barrier to supplement use is the lack of education and available supporting information regarding the indications, contraindications, and physiology of these adjuncts. The goal of this article is to provide a comprehensive, evidence-based review of available nutritional supplements that can be considered for the plastic surgery patient in the perioperative period to optimize surgical outcomes while minimizing risk. Prospective, well-designed studies using validated, high-quality supplements will be critical in determining the significance that perioperative supplementation can have for surgical outcomes. Until well-done prospective studies are performed, the supplement, dose, and duration should be determined on an individual, patient-per-patient basis at the discretion of the operating surgeon.
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Affiliation(s)
- Rebecca Knackstedt
- From the Department of Plastic Surgery, Cleveland Clinic; the Mayo Medical School; and the Division of Plastic Surgery, MetroHealth
| | - Jeremie Oliver
- From the Department of Plastic Surgery, Cleveland Clinic; the Mayo Medical School; and the Division of Plastic Surgery, MetroHealth
| | - James Gatherwright
- From the Department of Plastic Surgery, Cleveland Clinic; the Mayo Medical School; and the Division of Plastic Surgery, MetroHealth
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Sørensen LS, Rasmussen SL, Calder PC, Yilmaz MN, Schmidt EB, Thorlacius-Ussing O. Long-term outcomes after perioperative treatment with omega-3 fatty acid supplements in colorectal cancer. BJS Open 2020; 4:678-684. [PMID: 32391656 PMCID: PMC7397352 DOI: 10.1002/bjs5.50295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background This study aimed to evaluate the effect of perioperative supplementation with omega‐3 fatty acids (n‐3 FA) on perioperative outcomes and survival in patients undergoing colorectal cancer surgery. Methods Patients scheduled for elective resection of colorectal cancer between 2007 and 2010 were randomized to either an n‐3 FA‐enriched oral nutrition supplement (ONS) twice daily or a standard ONS (control) for 7 days before and after surgery. Outcome measures, including postoperative complications, 3‐year cumulative incidence of local or metastatic colorectal cancer recurrence and 5‐year overall survival, were compared between the groups. Results Of 148 patients enrolled in the study, 125 (65 patients receiving n‐3 FA‐enriched ONS and 60 receiving standard ONS) were analysed. There were no differences in postoperative complications after surgery (P = 0·544). The risk of disease recurrence at 3 years was similar (relative risk 1·66, 95 per cent c.i. 0·65 to 4·26).The 5‐year survival rate of patients treated with n‐3 FA was 69·2 (95 per cent c.i. 56·5 to 78·9) per cent, compared with 81·7 (69·3 to 89·4) per cent in the control group (P = 0·193). After adjustment for age, stage of disease and adjuvant chemotherapy, n‐3 FA was associated with higher mortality compared with controls (hazard ratio 1·73, 95 per cent c.i. 1·06 to 2·83; P = 0·029). The interaction between n‐3 FA and adjuvant chemotherapy was not statistically significant. Conclusion Perioperative supplementation with n‐3 FA did not confer a survival benefit in patients undergoing colorectal cancer surgery. n‐3 FA did not benefit the subgroup of patients treated with adjuvant chemotherapy or decrease the risk of disease recurrence.
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Affiliation(s)
- L Schmidt Sørensen
- Department of Gastrointestinal Surgery, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S Ladefoged Rasmussen
- Department of Gastrointestinal Surgery, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - P C Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | | | - E Berg Schmidt
- Department of Cardiology, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - O Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Rosenthal MD, Brown CJ, Loftus TJ, Vanzant EL, Croft CA, Martindale RG. Nutritional Management and Strategies for the Enterocutaneous Fistula. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00255-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Baba H, Tokai R, Hirano K, Watanabe T, Shibuya K, Hashimoto I, Hojo S, Yoshioka I, Okumura T, Nagata T, Fujii T. Risk factors for postoperative pneumonia after general and digestive surgery: a retrospective single-center study. Surg Today 2020; 50:460-468. [PMID: 31712912 DOI: 10.1007/s00595-019-01911-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Pneumonia is the second-most common complication in postoperative patients and is associated with significant morbidity and high costs of care. We aimed to determine the risk factors for pneumonia after general and digestive surgery. METHODS The medical records of 1,016 patients who underwent general and digestive surgery between January 2016 and March 2019 in our hospital were reviewed. RESULTS Of the 1,016 patients, 67 (6.6%) developed postoperative pneumonia. The multivariate analysis showed that significant predictors of postoperative pneumonia were a poor Eastern Cooperative Oncology Group performance status (ECOG-PS), low forced vital capacity and low forced expiratory volume in one second in the spirometry test, malnutrition (low serum albumin levels and low controlling nutritional status scores and prognostic nutritional index [PNI] values), esophagectomy, upper gastrointestinal surgery, and nonlaparoscopic surgery. Of these factors, the combination of PNI and ECOG-PS clearly stratified patients into low-, intermediate-, and high-risk groups with respect to developing postoperative pneumonia (area under the curve: 0.709). CONCLUSIONS Although postoperative pneumonia is associated with many clinical variables, active medical intervention for the prevention of pneumonia in patients with multiple risk factors can improve the postoperative course. In particular, perioperative nutritional care may prevent postoperative pneumonia in patients with malnutrition and a poor PS.
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Affiliation(s)
- Hayato Baba
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Ryutaro Tokai
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Katsuhisa Hirano
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Toru Watanabe
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Isaya Hashimoto
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
- Toyama Nishi General Hospital, Toyama, Japan
| | - Shozo Hojo
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Isaku Yoshioka
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tomoyuki Okumura
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takuya Nagata
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Postoperative prognostic nutritional index as a prognostic factor after non-small cell lung cancer surgery. Gen Thorac Cardiovasc Surg 2020; 68:1163-1171. [DOI: 10.1007/s11748-020-01366-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
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Martinez JL, Bosco-Garate I, Souza-Gallardo LM, Méndez JD, Juárez-Oropeza MA, Román-Ramos R, Ferat-Osorio E. Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial. J Gastrointest Surg 2020; 24:426-434. [PMID: 30710211 DOI: 10.1007/s11605-018-04099-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/28/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of glutamine and arginine has shown several advantages in postoperative outcomes in patients after gastrointestinal surgery. We determined the effects of its use in patients with enterocutaneous fistula after operative treatment. PATIENTS AND METHODS Forty patients with enterocutaneous fistula were randomly assigned to one of two groups. The control group received the standard medical care while the patients of the experimental group were supplemented with enteral administration of 4.5 g of arginine and 10 g of glutamine per day for 7 days prior to the surgery. The primary outcome variable was the recurrence of the fistula and the secondary outcomes were preoperative and postoperative serum concentrations of interleukin 6 and C-reactive protein and postoperative infectious complications. RESULTS Twenty patients were assigned to each group. The fistula recurred in two patients (10%) of the experimental group and in nine patients (45%) of the control group (P < 0.001). We found a total of 13 infectious complications in six patients of the control group (all with fistula recurrence) and none in the experimental group. Mean preoperative serum concentrations of interleukin 6 and C-reactive protein were lower in patients from the experimental group. In addition, these levels were lower in patients who had recurrence if compared to patients that did not recur. CONCLUSION Preoperative administration of oral arginine and glutamine could be valuable in the postoperative recovery of patients with enterocutaneous fistulas submitted to definitive surgery.
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Affiliation(s)
- Jose L Martinez
- Department of General and Gastrointestinal Surgery, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
- Programa de Doctorado en Ciencias Biológicas, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Ilka Bosco-Garate
- Unidad de Investigación Médica en Inmunoquímica, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Av.Cuauhtémoc 330, 3er piso, Colonia Doctores, Delegación Cuauhtémoc, 06720, Mexico City, Mexico
| | - Luis Manuel Souza-Gallardo
- Department of General and Gastrointestinal Surgery, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
| | - José D Méndez
- Unidad de Investigación Médica en Enfermedades Metabólicas, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
| | | | - Ruben Román-Ramos
- División Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Eduardo Ferat-Osorio
- Department of General and Gastrointestinal Surgery, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico.
- Unidad de Investigación Médica en Inmunoquímica, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Av.Cuauhtémoc 330, 3er piso, Colonia Doctores, Delegación Cuauhtémoc, 06720, Mexico City, Mexico.
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Preoperative immunonutrition in frail patients with colorectal cancer: an intervention to improve postoperative outcomes. Int J Colorectal Dis 2020; 35:19-27. [PMID: 31754818 DOI: 10.1007/s00384-019-03438-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study is to evaluate whether preoperative immunonutrition can shorten length of stay and improve postoperative outcomes in frail patients who are candidates for major oncologic colorectal surgery. METHODS A single center retrospective analysis of a prospectively collected database of frail patients, who underwent surgery with curative intent for colorectal cancer between January 2014 and December 2017, was performed. From March 2016, frail oncological patients undergoing major surgery were recommended to receive preoperative immunonutrition; their postoperative outcomes were compared to those of patients not treated with any preoperative nutritional support. Propensity score matching in a 1:1 ratio was used to balance patient characteristics. RESULTS Overall, 175 patients were included in the study. Of 74 patients receiving immunonutrition, 65 were matched with the group not treated with immunonutrition (n = 101). Baseline characteristics were comparable after matching. Although differences in postoperative length of stay were nonsignificant (p = 0.38), patients who received immunonutrition showed a shorter gastrointestinal (GI) recovery time (3.00 [2.00-4.00] versus 4.00 [2.00-5.00], p = 0.04), a lower rate of situs site infections complications (0.31 [0.10, 0.94], p = 0.04) and less need of antibiotic treatment (0.19 [0.06, 0.64], p = 0.01). CONCLUSION Preoperative immunonutrition was found to reduce both postoperative situs site infections and need of antibiotic treatment during the postoperative course. This study encourages the use of preoperative immune-enhancing nutrition as a part of multimodal prehabilitation programs in the management of frail colorectal cancer patients.
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Preoperative lymphocyte-to-monocyte ratio predicts postoperative infectious complications after laparoscopic colorectal cancer surgery. Int J Clin Oncol 2019; 25:633-640. [PMID: 31781993 DOI: 10.1007/s10147-019-01583-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/19/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Postoperative infectious complications (POI), which can increase length of hospital stay, medical cost, and worsen overall survival, are a concern in minimally invasive colorectal cancer (CRC) surgeries. Recent reports showed that relatively new inflammation-based score, lymphocyte-to-monocyte ratio (LMR) is an independent predictor of long-term outcomes after CRC surgeries. In this study, LMR was evaluated as a predictor of short-term postoperative outcomes. PATIENTS AND METHODS This was a single-institutional retrospective study of 211 consecutive patients who had undergone laparoscopic CRC surgery with primary tumor resection from January 2014 to August 2015 at Nippon Medical School Chiba Hokusoh Hospital. The patients were divided into two groups (no POI; n = 176 and POI; n = 35). The associations between inflammation-based scores, namely neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and LMR, and the occurrence of POI were investigated. Receiving operator characteristic curve analysis was used to determine the cutoff point of preoperative LMR. RESULTS Low LMR (cut-off 3.46), long operative time, and smoking were found to be independent predictors of POI in a multivariate analysis (LMR: Odds ratio 5.61, 95% confidence interval 1.98-15.9, P = 0.001). Patients with low LMR also appeared to have more advanced and aggressive tumours. CONCLUSION This is the first study to report that the lower LMR is a predictive factor of POI after laparoscopic CRC surgery, and it may provide additional information for treatment decisions to prevent POI.
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Black CS, Goltz DE, Ryan SP, Fletcher AN, Wellman SS, Bolognesi MP, Seyler TM. The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty. J Arthroplasty 2019; 34:2594-2600. [PMID: 31239176 DOI: 10.1016/j.arth.2019.05.060] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/08/2019] [Accepted: 05/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Research has linked malnutrition to more complications in total joint arthroplasty (TJA) patients. The role of preoperative albumin in predicting length of stay (LOS) and 90-day outcomes remains understudied. Often, an albumin cut-off ≤3.5 g/dL is used as proxy for malnutrition, although this value remains understudied. This preoperative level may be missing some patients at risk for adverse events post TJA. METHODS TJA patients at a single institution from 2013 to 2018 were reviewed for preoperative albumin level. In total, 4047 cases (total knee arthroplasty: 2058; total hip arthroplasty: 1989) had available data, including 90-day readmissions, 90-day emergency department (ED) visits, and postoperative LOS. RESULTS About 5.6% experienced a readmission and 9.6% had at least one ED visit within 90 days. Overall prevalence of malnutrition was 3.6%, and this cohort experienced a longer average LOS (3.5 vs 2.2 days, P < .0001) and was more likely to experience a readmission (16% vs 5%, P < .0001) or ED visit (18% vs 9%, P = .0005). Additionally, albumin ≤3.5 g/dL was correlated with more frequent discharge to skilled nursing facility/rehab (30.8% vs 14.7%, P < .0001), increased risk for 90-day readmission with univariable (odds ratio [OR] 1.79, P < .0001) and multivariable logistic regression (OR 1.55, P < .0001), and increased risk for 90-day ED visits with univariable (OR 1.62, P < .0001) and multivariable regression (OR 1.35, P < .0001). The optimal albumin cut-off was 3.94 g/dL in a univariable model for 90-day readmission. CONCLUSION Screening for malnutrition may serve a role in preoperative evaluation. An albumin cutoff value of 3.5 g/dL may miss some at-risk patients.
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Affiliation(s)
- Collin S Black
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Hogan S, Solomon M, Rangan A, Ferrie S, Carey S. The Impact of Preoperative Immunonutrition and Standard Polymeric Supplements on Patient Outcomes After Pelvic Exenteration Surgery, Taking Compliance Into Consideration: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr 2019; 44:806-814. [PMID: 31531997 DOI: 10.1002/jpen.1709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effect of immunonutrition vs standard polymeric nutrition in the preoperative phase on patient outcomes is still unclear, which could be due to contributing factors such as poorly reported compliance and unequal provision of protein, energy, and volume. The aim of this study was to examine the effects of preoperative immunonutrition compared with standard polymeric supplements matched for energy, protein, volume, length of stay, and postoperative complications in pelvic exenteration surgery, taking into consideration compliance. METHODS This was a single-blinded, randomized, controlled trial in patients undergoing pelvic exenteration surgery. Fifty-two participants were randomly assigned to consume 3 immunonutrition supplements/d for 5 days preoperatively, and 56 participants were randomly assigned to consume 3 standard polymeric supplements/d for 5 days preoperatively. Primary and secondary outcome measures were assessed. Compliance with each nutrition regime was recorded during the intervention, and subanalysis was conducted. RESULTS There was no significant difference between immunonutrition and standard polymeric supplements on length of stay (P = 0.988) or postoperative complications (P = 0.179) after pelvic exenteration surgery. Compliance with nutrition supplements was significantly less in malnourished (n = 33) compared with well-nourished participants (n = 74) (P = 0.016). Compliance varied between study groups, although not significant. CONCLUSION Preoperative immunonutrition did not significantly impact length of stay or postoperative complications compared with standard polymeric supplements after pelvic exenteration surgery, despite controlling for protein, energy, and volume. Compliance, protein, and energy may considerably impact the effect of immunonutrition, particularly in malnourished patients.
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Affiliation(s)
- Sophie Hogan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Anna Rangan
- University of Sydney, Sydney, New South Wales, Australia
| | - Suzie Ferrie
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Carey
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Adiamah A, Skořepa P, Weimann A, Lobo DN. The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis. Ann Surg 2019; 270:247-256. [PMID: 30817349 DOI: 10.1097/sla.0000000000003256] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define the influence of preoperative immune modulating nutrition (IMN) on postoperative outcomes in patients undergoing surgery for gastrointestinal cancer. BACKGROUND Although studies have shown that perioperative IMN may reduce postoperative infectious complications, many of these have included patients with benign and malignant disease, and the optimal timing of such an intervention is not clear. METHODS The Embase, Medline, and Cochrane databases were searched from 2000 to 2018, for prospective randomized controlled trials evaluating preoperative oral or enteral IMN in patients undergoing surgery for gastrointestinal cancer. The primary endpoint was the development of postoperative infectious complications. Secondary endpoints included postoperative noninfectious complications, length of stay, and up to 30-day mortality. The analysis was performed using RevMan v5.3 software. RESULTS Sixteen studies reporting on 1387 patients (715 IMN group, 672 control group) were included. Six of the included studies reported on a mixed population of patients undergoing all gastrointestinal cancer surgery. Of the remaining, 4 investigated IMN in colorectal cancer surgery, 2 in pancreatic surgery, and another 2 in patients undergoing surgery for gastric cancer. There was 1 study each on liver and esophageal cancer. The formulation of nutrition used in all studies in the treated patients was Impact (Novartis/Nestlé), which contains ω-3 fatty acids, arginine, and nucleotides. Preoperative IMN in patients undergoing surgery for gastrointestinal cancer reduced infectious complications [odds ratio (OR) 0.52, 95% confidence interval (CI) 0.38-0.71, P < 0.0001, I = 16%, n = 1387] and length of hospital stay (weighted mean difference -1.57 days, 95% CI -2.48 to -0.66, P = 0.0007, I = 34%, n = 995) when compared with control (isocaloric isonitrogeneous feed or normal diet). It, however, did not affect noninfectious complications (OR 0.98, 95% CI 0.73-1.33, P = 0.91, I = 0%, n = 1303) or mortality (OR 0.55, 95% CI 0.18-1.68, P = 0.29, I = 0%, n = 955). CONCLUSION Given the significant impact on infectious complications and a tendency to shorten length of stay, preoperative IMN should be encouraged in routine practice in patients undergoing surgery for gastrointestinal cancer.
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Affiliation(s)
- Alfred Adiamah
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Pavel Skořepa
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health, Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Arved Weimann
- Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Ruiz-Tovar J, Blanca M, Garcia A, Gonzalez J, Gutierrez S, Paniagua A, Prieto MJ, Ramallo L, Llanos L, Duran M. Preoperative administration of Omega-3 fatty acids on postoperative pain and acute-phase reactants in patients undergoing Roux-en-Y gastric bypass: A randomized clinical trial. Clin Nutr 2019; 38:1588-1593. [DOI: 10.1016/j.clnu.2018.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/20/2018] [Indexed: 11/26/2022]
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Russell K, Zhang HG, Gillanders LK, Bartlett ASJR, Fisk HL, Calder PC, Swan PJ, Plank LD. Preoperative immunonutrition in patients undergoing liver resection: A prospective randomized trial. World J Hepatol 2019; 11:305-317. [PMID: 30967908 PMCID: PMC6447421 DOI: 10.4254/wjh.v11.i3.305] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preoperative supplementation with immunonutrients, including arginine and n-3 fatty acids, has been shown in a number of systematic reviews to reduce infectious complications in patients who have undergone gastrointestinal surgery. Limited information, however, is available on the benefits of nutritional supplementation enriched with arginine and n-3 fatty acids in patients undergoing liver resection.
AIM To evaluate the effects of preoperative nutritional supplementation enriched with arginine and n-3 fatty acids on inflammatory and immunologic markers and clinical outcome in patients undergoing liver resection.
METHODS Thirty-four patients undergoing liver resection were randomized to either five days of preoperative Impact® [1020 kcal/d, immunonutrition (IMN) group], or standard care [no supplementation, standard care (STD) group]. Nutritional status was measured at study entry by subjective global assessment (SGA). Functional assessments (grip strength, fatigue and performance status) were carried out at study entry, on the day prior to surgery, and on postoperative day (POD) 7 and 30. Inflammatory and immune markers were measured at study entry, on the day prior to surgery, and POD 1, 3, 5, 7, 10 and 30. Postoperative complications were recorded prospectively until POD30.
RESULTS A total of 32 patients (17 IMN and 15 STD) were analysed. All except four patients were SGA class A. The plasma ratio of (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid was higher in IMN patients on the day prior to surgery and POD 1, 3, 5 and 7 (P < 0.05). Plasma interleukin (IL)-6 concentrations were elevated in the IMN group (P = 0.017 for POD7). No treatment effect was detected for functional measures, immune response (white cell count and total lymphocytes) or markers of inflammation (C-reactive protein, tumour necrosis factor-α, IL-8, IL-10). There were 10 patients with infectious complications in the IMN group and 4 in the STD group (P = 0.087). Median hospital stay was 9 (range 4–49) d in the IMN group and 8 (3-34) d in the STD group (P = 0.476).
CONCLUSION In well-nourished patients undergoing elective liver resection, this study failed to show any benefit of preoperative immunonutrition.
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Affiliation(s)
- Kylie Russell
- Nutrition Services, Auckland City Hospital, Auckland 1023, New Zealand
| | - Han-Guang Zhang
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
| | - Lyn K Gillanders
- Nutrition Services, Auckland City Hospital, Auckland 1023, New Zealand
| | - Adam SJR Bartlett
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland 1023, New Zealand
| | - Helena L Fisk
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO171BJ, United Kingdom
| | - Philip C Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO171BJ, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO166YD, United Kingdom
| | - Peter J Swan
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
| | - Lindsay D Plank
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
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Cui M, Liao Q, Zhao Y. Enteral Immunonutrition Promotes Immune and Inflammatory Recovery after Surgery for Gastric Cancer. J INVEST SURG 2019; 33:960-961. [PMID: 30897981 DOI: 10.1080/08941939.2019.1583295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ming Cui
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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Nelson CL, Kamath AF, Elkassabany NM, Guo Z, Liu J. The serum albumin threshold for increased perioperative complications after total hip arthroplasty is 3.0 g/dL. Hip Int 2019; 29:166-171. [PMID: 30415577 DOI: 10.1177/1120700018808704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: Low serum albumin is associated with higher perioperative complications following total hip arthroplasty (THA). The distinct threshold for a significant rise in perioperative complications has not been defined for THA. The purpose of this study was to define the threshold at which perioperative complications rise after THA. METHODS: We analysed the American College of Surgeons NSQIP database from 2006 to 2013. Our study cohort included unilateral primary THA with reported preoperative albumin levels. Patients were stratified by albumin level. We analysed mortality and 6 composite complication variables (any complication, any complication without transfusion, wound infection, systemic infection, cardiac/pulmonary complications, and any major complication). All data analysis was executed in STATA statistical software. Multivariable logistic regression analysis was used to adjust for odds ratios. RESULTS: The final cohort included 24,586 patients who were stratified based upon serum albumin levels. Odds ratios after multivariable regression adjustment for age, gender, race, body mass index, ASA classification, and Charlson Comorbidity Index indicated a trend to elevated odds of complication for all composite complications (3 of which were statistically significant) when serum albumin level was <3.0 g/dL. CONCLUSION: Low serum albumin is associated with increased perioperative complications following THA. The threshold associated with an increase in major perioperative complications appears to be an albumin level of <3.0 g/dL. With attempts to correct modifiable risk factors prior to surgery, the threshold value at which perioperative complications increase is important to define.
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Affiliation(s)
- Charles L Nelson
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Atul F Kamath
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Nabil M Elkassabany
- 2 Department of Anaesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Zhenggang Guo
- 3 Department of Anaesthesiology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing, China
| | - Jiabin Liu
- 4 Department of Anaesthesiology, Hospital for Special Surgery, New York, USA
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