Meta-analysis of immunonutrition in major abdominal surgery

Probst, Pascal; Ohmann, Susanne; Klaiber, Ulla; Hüttner, Felix J; Billeter, Adrian T.; Ulrich, Alexis; Büchler, Markus W.; Diener, Markus K.

doi:10.1002/bjs.10659

Cited by 98 publications

(49 citation statements)

References 91 publications

(156 reference statements)

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“…These conflicting results suggest that publication bias, which implies a tendency to withhold negative results of trials, may be present [20]. A recent meta-analysis reported that some of the measured significant effects were diminished if the biased trials were excluded [20].…”

Section: Discussionmentioning

confidence: 99%

Effect of preoperative immunonutrition on outcomes of colon cancer surgery: study protocol for a randomized controlled trial

Lee

Yeom

Kim

et al. 2020

Trials

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Background: Current guidelines recommend the prescription of immune-enriched oral nutritional supplements for malnourished patients before major gastrointestinal surgery. However, the benefit of preoperative immunonutrition is still controversial. This randomized controlled trial aims to evaluate the effect of preoperative immunonutrition on the outcomes of surgery for colon cancer. Methods/design: Patients with primary colon cancer will be included as study participants after screening. They will be randomly assigned (in a ratio of 1:1) to receive preoperative immunonutrition added to the normal diet (experimental arm) or consume normal diet alone (control arm). Patients in the experimental arm will receive oral supplementation (400 mL/day) with arginine and ω-3 fatty acids for 7 days before elective surgery. The primary endpoint is the rate of infectious complications, while the secondary endpoints are postoperative complication rate, change in body weight, length of hospital stay, and nature of fecal microbiome. The authors hypothesize that the rate of infectious complications would be 13% in the experimental arm and 30% in the control arm. With a twosided alpha of 0.05 and a power of 0.8, the sample size is calculated as 176 patients (88 per arm). Discussion: Although there have been many studies demonstrating significant benefits of preoperative immunonutrition, these were limited by a small sample size and potential publication bias. Despite the recommendation of immunonutrition before surgery in nutritional guidelines, its role in reduction of rate of infectious complications is still controversial. This trial is expected to provide evidence for the benefits of administration of preoperative immunonutrition in patients with colon cancer.

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Section: Discussionmentioning

confidence: 99%

Effect of preoperative immunonutrition on outcomes of colon cancer surgery: study protocol for a randomized controlled trial

Lee

Yeom

Kim

et al. 2020

Trials

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“…Therefore, prevention of postoperative pneumonia is important in improving short-term and long-term outcomes of GC. Although comprehensive interventions including perioperative pulmonary physiotherapy, respiratory exercises, and nutritional support are known to reduce the incidence of postoperative pneumonia, to the best of our knowledge, no clinical trials of these interventions have been conducted [39-41]. Therefore, clinical trials in which SIS is used as a predictor of postoperative pneumonia may result in improvement of management of patients after gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Systemic Inflammation Score as a Predictor of Pneumonia after Radical Resection of Gastric Cancer: Analysis of a Multi-Institutional Dataset

et al. 2020

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Background: Curative treatment for gastric cancer (GC) comprising gastrectomy with systematic lymph node dissection can result in postoperative complications. Postoperative pneumonia is sometimes fatal, like surgery-related complications such as anastomotic leakage. In this retrospective study, we analyzed a multi-institutional collaborative dataset with the aim of identifying predictors of postgastrectomy pneumonia. Methods: From a retrospective database of 3,484 patients who had undergone gastrectomy for GC at nine Japanese institutions between 2010 and 2014, 1,415 patients who met all eligibility criteria were identified as eligible for analysis. Predictive values of 31 candidate variables for postoperative pneumonia were assessed. Results: Forty-two patients (3.0%) had grade II or higher postoperative pneumonia. Preoperative systemic inflammation score (SIS) had the greatest area under the curve (0.655) for predicting postoperative pneumonia (optimal cutoff value = 2). The odds ratio (OR) of high SISs associated with postoperative pneumonia was 3.10 (95% confidence interval [CI], 1.54-6.07; p < 0.001). Multivariate binomial logistic analysis identified high SIS as an independent risk factor for postoperative pneumonia (OR, 2.31; 95% CI, 1.19-4.48; p = 0.013). A forest plot revealed that ORs of high SISs were highest in female patients. Conclusions: Our findings indicate that the preoperative SIS may serve as a simple predictor of postgastrectomy pneumonia, assisting physicians' efforts to take preventive measures against this complication.

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“…Major surgery which was defined as organ removal or normal surgical anatomy which has changed after peritoneal access as previously reported, including operations creating any gastrointestinal anastomosis or involving parenchymal resection of the liver, bile duct, spleen, or pancreas, were included [12,13]. In this study, we mainly included hepatectomy, pancreaticoduodenectomy, hilar cholangiocarcinoma radical surgery, and other hepatobiliary operations, and less extensive surgery such as cholecystectomy and liver tumor radiofrequency ablation was excluded.…”

Section: Patients Patients Who Underwent Major Hepatobiliary and Panmentioning

confidence: 99%

Nomograms Predicting the Occurrence of Sepsis in Patients following Major Hepatobiliary and Pancreatic Surgery

Zhang

Meng

2020

Gastroenterology Research and Practice

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Purpose. Sepsis is a severe complication in patients following major hepatobiliary and pancreatic surgery. The purpose of this study was to develop and validate a nomogram based on inflammation biomarkers and clinical characteristics. Methods. Patients who underwent major hepatobiliary and pancreatic surgery between June 2015 and April 2017 were retrospectively collected. Multivariate logistic regression was used to identify the independent risk factors associated with postoperative sepsis. A training cohort of 522 patients in an earlier period was used to develop the prediction models, and a validation cohort of 136 patients thereafter was used to validate the nomograms. Results. Sepsis developed in 55 of 522 patients of the training cohort and 19 of 136 patients in the validation cohort, respectively. In the training cohort, one nomogram based on clinical characteristics was developed. The clinical independent risk factors for postoperative sepsis include perioperative blood transfusion, diabetes, operative time, direct bilirubin, and BMI. Another nomogram was based on both clinical characteristics and inflammation biomarkers. Multivariate regression analyses showed that previous clinical risk factors, PCT, and CRP were independent risk factors for postoperative sepsis. The last nomogram showed a good C-index of 0.844 (95% CI, 0.787-0.900) compared with the previous one of 0.777 (95% CI, 0.713-0.840). Patients with a total score more than 109 in the second model are at high risk. The positive predictive value and negative predictive value of the second nomogram were 27% and 97%, respectively. Conclusion. The nomogram achieved good performances for predicting postoperative sepsis in patients by combining clinical and inflammation risk factors. This model can provide the early risk estimation of sepsis for patients following major hepatobiliary and pancreatic surgery.

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Meta-analysis of immunonutrition in major abdominal surgery

Cited by 98 publications

References 91 publications

Effect of preoperative immunonutrition on outcomes of colon cancer surgery: study protocol for a randomized controlled trial

Effect of preoperative immunonutrition on outcomes of colon cancer surgery: study protocol for a randomized controlled trial

Systemic Inflammation Score as a Predictor of Pneumonia after Radical Resection of Gastric Cancer: Analysis of a Multi-Institutional Dataset

Nomograms Predicting the Occurrence of Sepsis in Patients following Major Hepatobiliary and Pancreatic Surgery

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