Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol

Abstract

To compare immunonutrition versus standard high calorie nutrition in patients undergoing elective colorectal resection within an Enhanced Recovery After Surgery (ERAS) program.Despite progress in recent years in the surgical management of patients with colorectal cancer (ERAS programs), postoperative complications are frequent. Nutritional supplements enriched with immunonutrients have recently been introduced into clinical practice. However, the extent to which the combination of ERAS protocols and immunonutrition benefits patients undergoing colorectal cancer surgery is unknown.The SONVI study is a prospective, multicenter, randomized trial with 2 parallel treatment groups receiving either the study product (an immune-enhancing feed) or the control supplement (a hypercaloric hypernitrogenous supplement) for 7 days before colorectal resection and 5 days postoperatively.A total of 264 patients were randomized. At baseline, both groups were comparable in regards to age, sex, surgical risk, comorbidity, and analytical and nutritional parameters. The median length of the postoperative hospital stay was 5 days with no differences between the groups. A decrease in the total number of complications was observed in the immunonutrition group compared with the control group, primarily due to a significant decrease in infectious complications (23.8% vs. 10.7%, P = 0.0007). Of the infectious complications, wound infection differed significantly between the groups (16.4% vs. 5.7%, P = 0.0008). Other infectious complications were lower in the immunonutrition group but were not statistically significantly different.The implementation of ERAS protocols including immunonutrient-enriched supplements reduces the complications of patients undergoing colorectal resection.This study is registered with ClinicalTrial.gov: NCT02393976.

The Effect of Immunonutrition on the Postoperative Complications in Thymoma with Myasthenia Gravis

“…Although some studies showed no significant difference with hospital stay in immunonutrition group [33, 36], different outcome was observed in our study. We attribute the result to the choice of the subjects.…”

“…In addition, Rowan and his collaborators published their results that perioperative immunonutrition may lead to significant reductions of postoperative complications in high-risk head and neck cancer patients [32]. Moreover, Silvestri et al compared the clinical characteristics of patients after pancreaticoduodenectomy between immunonutrition group and control group and then obtained the result that immunonutrition helps to lower the risk of postoperative infectious complications and of hospital stays [33–35]. In our cohort, we obtained similar results with patients of thymoma with MG; the morbidity of postoperative complications, especially infectious complications, was significantly reduced in IN group.…”

“…Moya and his team studied the effect of immunonutrition on the patients under colorectal resection in an enhanced recovery after surgery (ERAS) protocol and drew a conclusion that the average postoperative hospital stay was not significantly different between the two groups. Their median postoperative hospital stay, which was only 5 days, maybe interfered by the applications of ERAS [33]. Song and his collaborators reviewed 9 studies involving 785 patients undergoing gastric resection concerning enteral immunonutrition and obtained a result that length of hospitalization was not improved, but they analysed that their outcome with heterogeneity caused by different compositions, different timing of administration of immunonutrient, insufficient quantity of sample size, and number of eligible researches in most of sensitive analyses with subgroup analysis may impair their conclusions [36].…”

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

“…The larger was a RCT of 264 patients that demonstrated a reduction in infectious complications (23.8% vs 10.7%; P = .0007), particularly wound infections (16.4% vs 5.7%; P = .0008) with the use of IMN when compared to standard high-calorie supplements. 82 In a separate study of IMN compared to dietary advice without supplementation by the same authors, wound infection rates in laparoscopic colectomy were significantly reduced with the use of IMN (11.5% vs 0%; P = .006). 83 A major real-world quality improvement effort using preoperative IMN in 3375 patients in Washington state demonstrated a reduction of 23% in the number of patients with a prolonged LOS (P = .05) in a covariate-matched analysis.…”

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

“…Although most of the included trials were from gastric/colon surgery, one study in gynecologic oncology supported these results 213. Several large randomized trials in colorectal patients compared an immune nutrition/high protein diet to a high calorie supplement and found a lower rate of infection and length of stay in the immune nutrition group 214. Higher post-operative protein intake is also associated with earlier discharge 215.…”