The Effect of Preoperative Oral Immunonutrition on Complications and Length of Hospital Stay After Elective Surgery for Pancreatic Cancer–A Randomized Controlled Trial

Gade, Josephine; Levring, T.; Hillingsø, Jens; Hansen, Carsten P.; Andersen, Jens Rikardt

doi:10.1080/01635581.2016.1142586

Cited by 43 publications

(58 citation statements)

References 22 publications

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“…These results suggest that modulation of Th1/Th2 differentiation and the Th17 response may play important roles in the immunologic effects of fish oil (85). One open, randomized controlled trial investigated the effect of supplementary oral immune-nutrition (250–1000 mL daily, Oral Impact®, Nestlé) seven days before surgery on postoperative complications and length of hospital stay in pancreatic cancer patients (87), however, no difference were observed.…”

Section: Methodsmentioning

confidence: 99%

Berries and other natural products in pancreatic cancer chemoprevention in human clinical trials

Pan

Skaer

et al. 2017

JBR

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Pancreatic ductal adenocarcinoma (PDAC) was the 12th and 11th most common cancer in men and women worldwide in 2012, with the highest incidence in North America and Europe and the lowest in Africa and Asia. Due to the lack of efficient early diagnosis and rapid disease progression, PDAC patients have a 5-year survival rate of just 5%. Epidemiological studies suggest that smoking, obesity, type II diabetes, and pancreatitis are common risk factors for PDAC development. By contrast, high intake of fresh fruit, vegetables, and nuts rich in phytochemicals could reduce PDAC risk. This review summarizes the human clinical studies that have used berries or other natural products for chemoprevention of PDAC. Developing chemopreventive agents against PDAC would be tremendously valuable for the high-risk population and patients with premalignant lesions. Although some clinical trials of these agents have been completed, most are in early phases, and the results are not promising, which may be due to administration of the natural products at advanced stages of PDAC. Thus, further mechanistic studies using genetic animal models that recapitulate the tumor microenvironment and immunology of human PDAC would be informative for selecting an effective window for intervention with berries or other natural compounds.

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Section: Methodsmentioning

confidence: 99%

Berries and other natural products in pancreatic cancer chemoprevention in human clinical trials

Pan

Skaer

et al. 2017

JBR

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“…1). Twenty-two RCTs were available for meta-analysis with 21 studies [20][21][22][23][24][25][26][27][28][29][30][32][33][34][35][36][37][38][39][40][41] providing results on overall infectious complications, 17 studies [20][21][22][24][25][26][27][30][31][32][33][34][36][37][38][39]41 on SSI, and 13 studies [20][21][22][25][26][27][28]30,[32][33][34]36,41 on 30-day mortality. Two prospective cohort studies…”

Section: Resultsmentioning

confidence: 99%

“…In the majority of the studies, the duration of follow-up was 30 days after surgery 26,28,32,36,38,41 , 30 days after discharge [20][21][22][23]27,31 or not reported [33][34][35]37,42,43 . In the rest, follow-up was until discharge (median length of hospital stay less than 30 days) 24,25,39,40 , 35 days after surgery 30 or 7 days after surgery 29 .…”

Section: Study Characteristicsmentioning

confidence: 99%

Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis

et al. 2020

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Background: Infectious complications occur in 4-22 per cent of patients undergoing surgical resection of malignant solid tumours. Improving the patient's immune system in relation to oncological surgery with immunonutrition may play an important role in reducing postoperative infections. A meta-analysis was undertaken to evaluate the potential clinical benefits of immunonutrition on postoperative infections and 30-day mortality in patients undergoing oncological surgery. Methods: PubMed, Embase and Cochrane Library databases were searched to identify eligible studies. Eligible studies had to include patients undergoing elective curative surgery for a solid malignant tumour and receiving immunonutrition orally before surgery, including patients who continued immunonutrition into the postoperative period. The main outcome was overall infectious complications; secondary outcomes were surgical-site infection (SSI) and 30-day mortality, described by relative risk (RR) with trial sequential analysis (TSA). Risk of bias was assessed according to Cochrane methodology. Results: Some 22 RCTs with 2159 participants were eligible for meta-analysis. Compared with the control group, immunonutrition reduced overall infectious complications (RR 0⋅58, 95 per cent c.i. 0⋅48 to 0⋅70; I 2 = 7 per cent; TSA-adjusted 95 per cent c.i. 0⋅28 to 1⋅21) and SSI (RR 0⋅65, 95 per cent c.i. 0⋅50 to 0⋅85; I 2 = 0 per cent; TSA-adjusted 95 per cent c.i. 0⋅21 to 2⋅04). Thirty-day mortality was not altered by immunonutrition (RR 0⋅69, 0⋅33 to 1⋅40; I 2 = 0 per cent). Conclusion: Immunonutrition reduced overall infectious complications, even after controlling for random error, and also reduced SSI. The quality of evidence was moderate, and mortality was not affected by immunonutrition (low quality). Oral immunonutrition merits consideration as a means of reducing overall infectious complications after cancer surgery.

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“…The main components of immunonutrition are arginine, glutamine and polyunsaturated ω-3 fatty acids.According to the recommendations of the enhanced recovery after surgery (ERAS), patients undergoing pancreatoduodenectomy may receive immunonutrition for 5-7 days perioperatively (evidence level: moderate, recommendation grade: weak) [10]. However, although immunomodulatory effects of immunonutrition have been the subject of a series of clinical research studies [7,8,[11][12][13][14][15][16] many unanswered questions remained. The key finding is that immunonutrition may reduce the incidence of infectious complications and the length of hospitalisation.…”

mentioning

confidence: 99%

Effects of Immunonutrition on Comprehensive Complication Index in Patients Undergoing Pancreatoduodenectomy

et al. 2020

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Background and objectives: Immunonutrition is recommended by enhanced recovery after surgery in patients undergoing pancreatoduodenectomy for 5–7 days perioperatively as it may reduce the rate of infectious complications. However, data on effect of immunonutrition on the overall complication rate are contradictory and it is not clear, which groups of patients benefit most. The aims of this study are to evaluate the effects of immunonutrition on the overall complication rate and the rate of severe and/or multiple complications in patients with pancreatic tumours stratified according to final histological diagnosis—patients with pancreatic ductal adenocarcinoma (PDAC) vs. other tumours—and nutritional state, using more sensitive Comprehensive Complication Index. Materials and Methods: Seventy consecutive patients scheduled for pancreatoduodenectomy because of pancreatic tumours were randomised into immunonutrition vs. control groups and stratified according to final histological diagnosis and nutritional status. Surgical outcomes were assessed postoperatively using Clavien—Dindo classification (CDC) and Comprehensive Complication Index (CCI). Results: No significant differences in the overall complication rates in immunonutrition vs. control, patients with malnutrition vs. no malnutrition, PDAC vs. other pancreatic tumours groups were detected. However, significant differences in the rates of severe and/or multiple complications in immunonutrition vs. control groups and in PDAC patients segregated according to immunonutrition were obtained using CCI. Conclusions: Patients with PDAC may experience greater benefits of immunonutrition as compared to patients with benign pancreatic diseases or less aggressive tumours, while nutritional status was not a determining factor for the efficacy of immunonutrition.

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The Effect of Preoperative Oral Immunonutrition on Complications and Length of Hospital Stay After Elective Surgery for Pancreatic Cancer–A Randomized Controlled Trial

Cited by 43 publications

References 22 publications

Berries and other natural products in pancreatic cancer chemoprevention in human clinical trials

Berries and other natural products in pancreatic cancer chemoprevention in human clinical trials

Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis

Effects of Immunonutrition on Comprehensive Complication Index in Patients Undergoing Pancreatoduodenectomy

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