Optimizing Nutritional Status in Patients Undergoing Radical Cystectomy: A Systematic Scoping Review

Alam, Syed M.; Michel, Carrie; Robertson, Hilary L.; Camargo, Juliana; Linares, Brenda; Holzbeierlein, Jeffrey M.; Hamilton-Reeves, Jill

doi:10.3233/blc-200428

Cited by 6 publications

(3 citation statements)

References 49 publications

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“…In a Systematic Review by Alan et al and a Cochrane review, the authors assigned a low quality of evidence to the study due to imprecision errors and the small sample size, which limited the study findings [ 21 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

et al. 2023

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Introduction: There is a large body of evidence about immunonutrition formulas; however, there are still doubts about their usefulness in routine clinical practice as compared with standard formulas. In the age of personalized medicine, new studies appear every year regarding several types of patients; therefore, an updated point of view on these formulas is necessary. Methods: The Embase database was searched from 2016 to 14 March 2022. Our criteria were articles published in English and Spanish. The evidence quality was evaluated using GRADEpro, and the review was developed according to the PRISMA statement. Results: In this review, a total of 65 unique records were retrieved; however, 36 articles did not meet the inclusion criteria and were thus excluded. In total, 29 articles were included in the final analysis. In the last few years, many meta-analyses have attempted to identify additional existing studies of surgical patients with certain pathologies, mainly oncological patients. Immunonutrition prior to oncological surgery was shown to cause a decrease in inflammatory markers in most of the studies, and the main clinical events that changed were the infectious complications after surgery. The length of stay and mortality data are controversial due to the specific risk factors associated with these events. Conclusions: The use of immunonutrition in patients who have undergone oncological surgery decreases the levels of inflammatory markers and infectious postoperative complications in almost all localizations. However, more studies are needed to assess the use of immunonutrition based on Enhanced Recovery After Surgery (ERAS) protocols.

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Section: Resultsmentioning

confidence: 99%

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

et al. 2023

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“…Such individuals often face nutritional challenges like appetite loss, nausea, vomiting, and alterations in taste perception [ 31 , 32 ], underscoring the importance of addressing nutritional needs as part of a comprehensive and targeted preoperative management. As elucidated by two studies, [ 33 , 34 ] oral supplements and immunonutrition emerge as promising treatments for mitigating postoperative complications and expediting recovery in RC patients.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

Dal Bello,

Mancin,

Morales Palomares

et al. 2024

Nutrients

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Background/Aim: Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy. Methods: A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence. Results: Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73–0.93; p = 0.0029) and decrease postoperative complications (−36.7%; p = 0.008) and readmission rates (−15.38%; p = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (−1 day; p < 0.01), a reduction in the length of hospital stay (−1.75 days; p = 0.01), an improvement in handgrip strength (+6.8%, p < 0.001), an increase in bone mass (+0.3 kg, p = 0.04), and a better BMI value (+2.3%, p = 0.001). Conclusions: Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results.

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“…Otherwise, Hamilton-Reeves' studies excluded malnourished patients according to weight loss and BMI criteria [39,40]. Two recent reviews [52,53] assigned a low quality of evidence to some of the described studies due to imprecision errors and small sample size. Unfortunately, the differences in terms of study design, clinical endpoints, sample size, timing of nutritional intervention, and type of immunonutrition supplements do not enable a proper comparison of the results or to draw solid conclusions.…”

Section: Discussionmentioning

confidence: 99%

Immunonutrition in Radical Cystectomy: State of the Art and Perspectives

Casirati,

Da Prat,

Bettiga

et al. 2023

Cancers

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Preoperative nutritional status is a pivotal aspect to consider in patients with cancer undergoing radical cystectomy (RC), as those at risk of malnutrition or already malnourished are more prone to post-surgical complications. The loss of muscle mass is a major consequence of cancer-related malnutrition. It is associated with increased risk of hospital readmission, longer hospitalization, and higher mortality. Nowadays, the close relationship between nutritional and immunological aspects under stressful conditions, such as surgery, represents an emerging scientific and clinical issue. Indeed, the synergistic action of reduced food intake and systemic inflammation generates metabolic derangements with tissue catabolism, including skeletal muscle breakdown, which is, in turn, associated with immune system dysfunction. In order to offer an additional immune-nutritional boost to the post-surgical phase, particularly in malnourished patients, nutritional support may include oral nutritional supplements and/or enteral formulas enriched with specific nutrients such as omega-3 fatty acids, arginine, glutamine, and nucleotides, with acknowledged immune-modulating effects. In the present narrative review, we addressed the state of the art of the available scientific literature on the benefit of immunonutrition in patients undergoing RC for cancer and suggest possible future perspectives to be explored. Although the role of immunonutrition was found to be little explored in the context of urologic oncology, the preliminary available data on radical cystectomy, summarized in the present paper, are promising and suggest that it may improve postoperative outcomes through immunomodulation, regardless of nutritional status before surgery.

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Optimizing Nutritional Status in Patients Undergoing Radical Cystectomy: A Systematic Scoping Review

Cited by 6 publications

References 49 publications

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

Immunonutrition in Radical Cystectomy: State of the Art and Perspectives

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