Preoperative immunonutrition and carbohydrate loading associated with improved bowel function after radical cystectomy

Abstract

Background: Preoperative malnourishment has been consistently associated with poor outcomes after radical cystectomy and other major abdominal surgeries. Most enhanced recovery after surgery (ERAS) studies have examined preoperative nutrition and its relationship to outcomes after gastrointestinal surgery.Although numerous studies have demonstrated the benefits of using an ERAS protocol, this study in unique in comparing 2 ERAS protocols, with and without a nutrition component. Methods: A formalized preoperative nutrition protocol (PNP) recommending use of preoperative immunonutrition and carbohydrate drink was introduced in June 2018. A total of 78 consecutive patients who drank both beverages were compared with 92 historical controls. Multivariable logistic regression analyses were sequentially performed to determine if preoperative nutrition was associated with binary outcome variables (30-day complication, infectious complication, and readmission within 30 days). Results: The preoperative nutrition group and control group were statistically similar in distribution of age, sex, American Society of Anesthesiologists physical status classification, clinical stage, and body mass index. Return of bowel function was found to occur earlier in the preoperative nutrition group than in the control group (3.12 vs 3.74 days; relative risk, 0.82; CI, 0.73-0.93; P = .0029). Complications within 30 days were similar in both groups (63.6% vs 55.4%; P = 0.36). Infectious complications (42.9% vs 37%; P = .53) and readmission within 30 days (22.1% vs 15.2%; P = .34) were also similar in both groups.Conclusions: Use of a PNP including immunonutrition and carbohydrate drink may be associated with earlier return of bowel function after radical cystectomy.

Effects of Preoperative Oral Carbohydrate Loading on Neutrophil/Lymphocyte Ratio and Postoperative Complications following Colorectal Cancer Surgery: A Randomized Controlled Study

“…Conventional preoperative fasting aims to minimize the risk of pulmonary aspiration but increases catabolic shift and acute-phase inflammatory markers [16]. Evidence suggests the beneficial effects of preoperative CHO loading on reducing IR [10] and cytokine levels [17] and improving bowel function [18]; however, the impact of preoperative CHO loading on postoperative NLR as an inflammatory and immunology-based predictor remains unclear. CHO, preoperative carbohydrate loading group; WBC, white blood cell; SD, standard deviation; Preop, 06:00 h on the day of surgery; POD1, 06:00 h on postoperative day 1; POD3, 06:00 h on postoperative day 3; POD5, 06:00 h on postoperative day 5; NLR, neutrophil-to-lymphocyte ratio.…”

“…Conventional preoperative fasting aims to minimize the risk of pulmonary aspiration but increases catabolic shift and acute-phase inflammatory markers [16]. Evidence suggests the beneficial effects of preoperative CHO loading on reducing IR [10] and cytokine levels [17] and improving bowel function [18]; however, the impact of preoperative CHO loading on postoperative NLR as an inflammatory and immunology-based predictor remains unclear.…”

Effects of preoperative immunonutrition with surgical site infection after radical cystectomy and ileal conduit for muscle invasive bladder cancer

“…4 However, there have been only few reports on the effectiveness of immunonutrition in MIBC and in small-sized or retrospective studies. [7][8][9][10] In 2021, Khaleel et al reported in a relatively large number of cases (n = 204) that intake of IMPACT for 5 days before surgery signi cantly reduced postoperative infectious complications after radical cystectomy and urinary diversion. 11 Our study also showed that preoperative intake of IMPACT signi cantly reduced the incidence of SSI.…”

Preoperative optimization of the radical cystectomy patient: Current state and future directions

“…54 Another study by Patel and colleagues comparing preoperative IMN to carbohydrate loading demonstrated earlier return of bowel function with IMN (3.12 vs. 3.74, p = 0.003) but did not demonstrate significant differences in other postoperative outcomes. 55 The Southwest Oncology Group (SWOG) S1600 Randomized Phase III clinical trial recently closed accrual and is investigating the effectiveness of IMN in patients undergoing RC with the primary endpoint being 30-day complications. 56 The study enrolled 200 patients and randomized 1:1 to either IMN or standard of care.…”