Perioperative Immunonutrition in Patients Undergoing Cancer Surgery

Braga, Marco; Gianotti, Luca; Radaelli, Giovanni; Vignali, Andrea; Mari, Giulio; Gentilini, Oreste; Carlo, V. Di

doi:10.1001/archsurg.134.4.428

Cited by 315 publications

(190 citation statements)

References 25 publications

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“…These included 9 RCTs (82,84,90,104,111,120,123,125,126) and 1 non-RCT (116) comparing nutritional support with routine care, 3 RCTs comparing EPA provided as either enriched ETF (102,124) or capsules (46) with routine care, and 15 RCTs comparing ETF with PN (76,80,83,85,86,90,93,98,103,112,115,117,118,122,127). One study provided data both for analysis of nutritional support vs. routine care, and ETF vs. PN (90).…”

Section: Resultsmentioning

confidence: 99%

“…The majority (n=23) utilised ETF, with only 4 studies using ONS (84,104) or a combination of oral and tube routes (46,82). The type of cancer varied; most (n=24) were gastrointestinal (46,76,80,(82)(83)(84)(85)(86)90,93,98,(102)(103)(104)111,112,115,117,118,120,(123)(124)(125)127), with 3 studies on patients with head/neck (116,126) and liver cancer (122).…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies were RCTs (n=47) (21,46,47,74-77,79,80,82-88,90,91,93-98,100-104, 106-109,111-115,117,118,120,122-127), scoring the highest grade of 1 for quality of evidence in accordance with the assessment scale (67). However, the methodology of individual RCTs was generally judged to be poorly described or planned (with regard to methods of randomisation, blinding and recording the number of drop-outs) with only 7 studies (75,80,82,88,96,104,120) scoring the top grade of 5 on the Jadad scale (68). The remaining RCTs scored 4 (n=3; (46,101,124) Table II.…”

Section: Resultsmentioning

confidence: 99%

“…ONS and ETF had no significant effects on other biochemical parameters in patients undergoing surgery. One RCT using postoperative ETF (nasojejunal) for 7 days in oesophageal cancer patients reported no significant effect from nutritional support on serum transferrin (111); another RCT was more difficult to interpret due to missing control data (82). Five RCTs with surgical patients reported no significant difference in serum albumin concentration following nutritional support vs. routine care, but were not meta-analysable due to undefined units (111), incomplete data (126) or missing data (123).…”

Section: Haematological and Biochemical Outcomesmentioning

confidence: 99%

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Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Elia

Schueren

Garvey³

et al. 2006

Int J Oncol

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Abstract. The aim of this systematic review was to determine the efficacy and potential benefits of enteral nutritional support [oral nutritional supplements (ONS) or enteral tube feeding (ETF)], and eicosapentaenoic acid (EPA, free acid, ethyl esters or fish oil; provided as capsules or enriched ONS or ETF) in patients with cancer. Clinical studies were identified using electronic databases, and studies were selected according to predetermined criteria. For each treatment modality (chemo/radiotherapy, surgery, and palliative care), the comparisons of interest were nutritional support vs. routine care (no nutritional support), EPA supplement (capsule or enriched ONS or ETF) vs. routine care (no supplement or standard supplement), ETF vs. parenteral nutrition (PN). The reviewed outcomes were dietary intake, anthropometry, clinical (mortality, length of hospital stay, complications, and quality of life) and haematological/biochemical (white blood cell count, serum transferrin and albumin, CD3-positive lymphocytes, and inflammatory markers). Meta-analyses were performed where possible. In patients undergoing radiotherapy, meta-analysis showed that ONS significantly increase dietary intake (381 kcal/day, 95% CI 193 to 569 in 3 RCTs) compared to routine care. In patients undergoing surgery, meta-analyses showed that ETF results in a significantly shorter length of hospital stay (1.72 fewer days, 95% CI 0.90 to 2.54 in 8 RCTs), lower incidence of any complications (OR 0.62, 95% CI 0.50 to 0.77 in 4 RCTs) and infectious complications (OR 0.67, 95% CI 0.55 to 0.82 in 11 RCTs) and lower sepsis scores (2.21 points, 95% CI 1.49 to 2.92 in 2 RCTs), but no difference in mortality (OR 0.72, 95% CI 0.40 to 1.29 in 7 RCTs) compared to PN. There was also no difference in mortality between ONS or ETF vs. routine care in patients undergoing chemotherapy/radiotherapy (OR 1.00, 95% CI 0.62-1.61 in 4 RCTs) or surgery (OR 2.44, 95% CI 0.75 to 7.95 in 4 RCTs). Individual studies of EPA supplementation as capsules showed improvements in survival, complications and inflammatory markers in patients undergoing bone marrow transplant (BMT). In palliative care patients receiving EPA-enriched ONS or capsules, there were inconsistent positive effects on survival and quality of life. In those undergoing surgery, EPA-enriched ETF had no effect. Further research is required to elucidate the clinical efficacy of enteral nutrition support, including the potential benefits of EPA supplementation, in patients with cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Haematological and Biochemical Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Elia

Schueren

Garvey³

et al. 2006

Int J Oncol

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“…Immunonutrition is usually given preoperatively, since it prevents the decrease in cellular immunity and phagocytic capacity of polymorphonuclear neutrophils (PMN's) during the early postoperative period [9] . There have been several prospective studies examining the effects of immunonutrition support on the rate of postoperative complications, infection rates, length of hospital stay, wound repair, weight gain, cost, and mortality [10][11][12][13][14][15] . However, the mechanisms through which beneficial effects occur have not been studied in detail.…”

Section: Introductionmentioning

confidence: 99%

Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

Günerhan¹,

Köksal²,

Sahin³

et al. 2009

WJG

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AIM:To e va l u a t e t h e e f fe c t s o f p r e o p e ra t i v e immunonutrition and other nutrition models on the cellular immunity parameters of patients with gastrointestinal tumors before surgical intervention. In addition, effects on postoperative complications were examined. METHODS:Patients with gastrointestinal tumors were randomized into 3 groups. The immunonutrition group received a combination of arginine, fatty acids and nucleotides. The second and third group received normal nutrition and standard enteral nutrition, respectively. Nutrition protocols were administered for 7 d prior to the operation. Nutritional parameters, in particular prealbumin levels and lymphocyte subpopulations (CD4+, CD8+, CD16+/56+, and CD69 cells) were evaluated before and after the nutrition protocols. Groups were compared in terms of postoperative complications and duration of hospital stay. RESULTS:Of the 42 patients who completed the study, 16 received immunonutrition, 13 received normal nutrition and 13 received standard enteral nutrition. prealbumin values were low in every group, but this parameter was improved after the nutritional protocol only in the immunonutrition group (13.64 ± 8.83 vs 15.98 ± 8.66, P = 0.037). Groups were similar in terms of CD4+, CD16+/56, and CD69+ prior to the nutritional protocol; whereas CD8+ was higher in the standard nutrition group compared to the immunonutrition group. After nutritional protocols, none of the groups had an increase in their lymphocyte subpopulations. Also, groups did not differ in terms of postoperative complications and postoperative durations of hospital stay.CONCLUSION: P re o p e ra t i ve i m m u n o n u t r i t i o n provided a significant increase in prealbumin levels, while it did not significantly alter T lymphocyte subpopulation counts, the rate of postoperative complications and the duration of hospital stay.

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Outcome and Cost-effectiveness of Perioperative Enteral Immunonutrition in Patients Undergoing Elective Upper Gastrointestinal Tract Surgery

Senkal

Zumtobel²,

Bauer³

et al. 1999

Arch Surg

266

166

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Perioperative Immunonutrition in Patients Undergoing Cancer Surgery

Cited by 315 publications

References 25 publications

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

Outcome and Cost-effectiveness of Perioperative Enteral Immunonutrition in Patients Undergoing Elective Upper Gastrointestinal Tract Surgery

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