The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for GI Cancer
Preoperative use of IMPACT® formulas decreased the risk of infectious complications by ~50% in patients undergoing GI cancer surgery.
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
Comparison | Infectious Complications | Length of Stay (LOS) |
|---|---|---|
IM formulas vs. IN/IC | Infectious ComplicationsOdds Ratio (OR) 0.49(95% CI 0.28, 0.85, p=0.01) | Length of Stay (LOS)−1.06 days(−2.76, 0.63, p=0.22) |
IM formulas vs. no supplementation | Infectious ComplicationsOR 0.52(95% CI 0.35, 0.78, p=0.001) | Length of Stay (LOS)−2.06 days(−3.07, −1.06, p<0.0001) |
IM formulas vs. controls combined (all studies) | Infectious ComplicationsOR 0.52(95% CI 0.38, 0.71, p<0.0001) | Length of Stay (LOS)−1.57 days(−2.48, −0.66, p=0.0007) |
- A large decrease in risk of infectious complications was shown when IM formulas were compared with IN/IC controls, 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.
- 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.