Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis

Abstract

PurposeImmunonutrition has been used to prevent the complications after colorectal elective surgery. This systematic review aimed to analyze and assess the effect of immunonutrition on colorectal cancer patients who received elective surgery.MethodsThree electronic databases (Medline, Embase, Cochrane) were used to search the latent studies which investigated the effects of enteral immunonutrition (EIN) compared with standard enteral nutrition (EN) or parenteral immunonutrition (PIN) compared with standard parenteral nutrition (PN) on colorectal cancer patients who are undergoing surgery until 21st of April, 2017. Meta-analysis was conducted to calculate odd risk (OR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI), and heterogeneity was tested by Q test.ResultsNine publications were included. The meta-analysis results presented that EIN improved the length of hospital stay (pooled MD, 2.53; 95% CI, 1.29–3.41), infectious complications (pooled OR, 0.33; 95% CI, 0.21–0.53) which contains the Surgical Site Infections (pooled OR, 0.25; 95% CI, 0.22–0.58) and Superficial/Deep incisional infections (pooled OR, 0.27; 95% CI, 0.12–0.64); meanwhile, PIN improved the length of hospital stay (pooled MD, 2.66; 95% CI, 0.62–4.76), IL-6 (pooled MD, − 6.09; 95% CI, − 10.11 to − 2.07), CD3 (pooled MD, 7.50; 95% CI, 3.57–11.43), CD4 (pooled MD, 5.47; 95% CI, 2.54–8.40), and CD4/CD8 (pooled MD, 0.50; 95% CI, 0.22–0.78); the level of CD8 was lower (pooled MD, − 4.32; 95% CI, − 7.09 to − 1.55) in PIN.ConclusionImmunonutrition could be an effective approach to enhance the immune function of colorectal cancer patients undergoing elective surgery and to improve the clinical and laboratory outcomes.Electronic supplementary materialThe online version of this article (10.1007/s00384-017-2958-6) contains supplementary material, which is available to authorized users.

Immunomodulating Activity and Therapeutic Effects of Short Chain Fatty Acids and Tryptophan Post-biotics in Inflammatory Bowel Disease

“…This acute nutritional deficiency is potentially modifiable and has been the target of nutritional optimization around the surgery time. Nutritional supplements enriched with immunonutrients have recently been introduced into clinical practice for patients undergoing cancer surgery (109). Theoretically, the role of these immunonutrients administered in the perioperative period could be similar in oncologic patients in order to decrease the incidence of surgical complications, in particular infectious complications.…”

Optimal Nutrition Formulas for Patients Undergoing Surgery for Colorectal Cancer: A Bayesian Network Analysis

“…A meta-analysis of immunonutrition has been previously performed in colorectal cancer patients to study its functional mechanism and clinical use. Xu et al performed a direct comparison of meta-analyses comparing immunonutrition with standard nutrition in colorectal cancer patients who underwent surgery and suggested that regardless of the enteral or parenteral route and different nutrition formulas, immunonutrition was effective in reducing infectious complications and length of hospital stays (31). However, when comparing each immunonutrition formula alone with standard nutrition, the results suggested that different formulas had different advantages in clinical outcomes (14)(15)(16).…”

Enhanced recovery after rectal surgery: what we have learned so far

“…Immunonutrition is associated with reduced rate of complications and reduced length of stay [106,107] . In fact, it has been demonstrated that the administration of nutritional supplements containing mainly glutamine, arginine, omega-3 fatty acid and ribonucleic acid is able to reduce the inflammation and improve the immune response.…”

“…The mechanism of action of immunonutrition has not been fully clarified yet. Apparently, its main effect is to reduce bacterial translocation by maintaining the integrity of the intestinal mucosa and reducing its permeability, thus reducing the risk of infectious complications [107] .…”