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.

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.

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

• Journal Article Type: Article
• Acceptance Date: Feb 14, 2019
• Online Publication Date: Feb 26, 2019
• Publication Date: Aug 1, 2019
• Deposit Date: Feb 22, 2019
• Publicly Available Date: Mar 13, 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
• DOI: https://doi.org/10.1097/SLA.0000000000003256
• Keywords: Immune modulating nutrition; Gastrointestinal cancer; Cancer surgery
• Public URL: https://nottingham-repository.worktribe.com/output/1578221
• Publisher URL: https://insights.ovid.com/crossref?an=00000658-900000000-95198
• Contract Date: Feb 22, 2019