The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer
Adiamah A, Skořepa P, Weimann A and Lobo DN. Ann Surg 2019; 270(2): 247-256.
Objective:
To systematically review the preoperative use of immunonutrition (containing all combinations of arginine, glutamine, n-3 fatty acids and nucleotides) in GI cancer surgery studies measuring at least one clinical outcome.
Methods:
16 randomized controlled trials (n=1387) with either isonitrogenous, isocaloric (IN/IC) controls (6 trials) or no supplementation (10 trials) were meta-analyzed. 6 trials had a mixed GI cancer surgery population, 4 were colorectal, 2 pancreatic, 2 gastric and 1 each liver and esophageal cancer. All trials evaluated the immunonutrition (IM) blend of supplemental arginine, n-3 fatty acids and nucleotides found in IMPACT® formulas.
Results:
✔ A large decrease in risk of infectious complications was shown when IM formula were compared with IN/IC controls, and this demonstrating the value of the immunonutrient blend apart from supplementing calories and protein.
✔ Regardless of the control compared, use of this specific IM formulation prior to GI cancer surgery decreased the risk of infectious complications by ~50%.
✔ Significant LOS reductions were associated with IM formulas used prior to GI cancer surgery among all studies analyzed, and when controls were unsupplemented.
✔ Differences between groups for non-infectious complications and mortality were not found.
Conclusion:
• Preoperative use of IMPACT® formulas is superior to standard oral nutritional supplements in GI cancer surgery patients.
• A minimum of 5 days of preoperative IMPACT® formula, orally or enterally should be part of routine practice in the care of GI cancer surgery patients.
Summary prepared by Nestlé Health Science. Download PDF of Summary
The complete study may be accessed online: https://www.ncbi.nlm.nih.gov/pubmed/30817349
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