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The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis

Adiamah, Alfred; Skořepa, Pavel; Weimann, Arved; Lobo, Dileep N.

Authors

Alfred Adiamah

Pavel Skořepa

Arved Weimann

DILEEP LOBO dileep.lobo@nottingham.ac.uk
Professor of Gastrointestinal Surgery



Abstract

Objective: To define the influence of preoperative immune modulating nutrition (IMN) on postoperative outcomes in patients undergoing surgery for gastrointestinal cancer.

Summary background data: 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 end point was the development of postoperative infectious complications. Secondary end points included postoperative non-infectious 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, four investigated IMN in colorectal cancer surgery, two in pancreatic surgery and another two in patients undergoing surgery for gastric cancer. There was one study each on liver and esophageal cancer. The formulation of nutrition used in all studies in the treated patients was ImpactR
(Novartis/Nestle), 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 to 0.71, p [less than] 0.0001, I2=16%, n=1387] and length of hospital stay [weighted mean difference -1.57 days, 95% CI -2.48 to -0.66, p=0.0007, I2=34%, n=995) when compared with control (isocaloric isonitrogeneous feed or normal diet). It, however, did not affect non-infectious complications (OR 0.98, 95% CI 0.73 to 1.33, p=0.91, I2=0%, n=1303) or mortality (OR 0.55, 95% CI 0.18 to 1.68, p=0.29, I2=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.

Journal Article Type Article
Publication Date Aug 1, 2019
Journal Annals of Surgery
Print ISSN 0003-4932
Electronic ISSN 1528-1140
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 270
Issue 2
Pages 247-246
APA6 Citation Adiamah, A., Skořepa, P., Weimann, A., & Lobo, D. N. (2019). The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis. Annals of Surgery, 270(2), 247-246. https://doi.org/10.1097/SLA.0000000000003256
DOI https://doi.org/10.1097/SLA.0000000000003256
Keywords Immune modulating nutrition; Gastrointestinal cancer; Cancer surgery;
Publisher URL https://insights.ovid.com/crossref?an=00000658-900000000-95198

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