Effects of Enteral Immunonutrition in Esophageal Cancer

Mimatsu, Kenji; Fukino, Nobutada; Ogasawara, Yasuo; Saino, Yoko; Oida, Takatsugu

doi:10.1159/000481797

Cited by 4 publications

(2 citation statements)

References 42 publications

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“…For thoracic surgery patients, the aim of GDFT is not only to decrease intraoperative fluid infusion but also to optimize end-organ perfusion with appropriate fluids based on dynamic parameters, thus stabilizing hemodynamic status [ 16 ]. Furthermore, patients with esophageal cancer are at risk for preoperative malnutrition [ 44 ]. In addition to selecting the optimal fluid resuscitation mode during surgery, it is also important to optimize perioperative fluid management by replacing intravenous fluids with the early resumption of oral fluids and diet [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of perioperative goal-directed fluid therapy on postoperative complications after thoracic surgery with one-lung ventilation: a systematic review and meta-analysis

Li,

Zhang,

Zhu

et al. 2023

World J Surg Onc

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Background An understanding of the impact of goal-directed fluid therapy (GDFT) on the outcomes of patients undergoing one-lung ventilation (OLV) for thoracic surgery remains incomplete and controversial. This meta-analysis aimed to assess the effect of GDFT compared to other fluid therapy strategies on the incidence of postoperative complications in patients with OLV. Methods The Embase, Cochrane Library, Web of Science, and MEDLINE via PubMed databases were searched from their inception to November 30, 2022. Forest plots were constructed to present the results of the meta-analysis. The quality of the included studies was evaluated using the Cochrane Collaboration tool and Risk Of Bias In Non-Randomized Study of Interventions (ROBINS-I). The primary outcome was the incidence of postoperative complications. Secondary outcomes were the length of hospital stay, PaO2/FiO2 ratio, total fluid infusion, inflammatory factors (TNF-α, IL-6), and postoperative bowel function recovery time. Results A total of 1318 patients from 11 studies were included in this review. The GDFT group had a lower incidence of postoperative complications [odds ratio (OR), 0.47; 95% confidence interval (95% CI), 0.29–0.75; P = 0.002; I2, 67%], postoperative pulmonary complications (OR 0.48, 95% CI 0.27–0.83; P = 0.009), and postoperative anastomotic leakage (OR 0.51, 95% CI 0.27–0.97; P = 0.04). The GDFT strategy reduces total fluid infusion. Conclusions GDFT is associated with lower postoperative complications and better survival outcomes after thoracic surgery for OLV.

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Section: Discussionmentioning

confidence: 99%

Effect of perioperative goal-directed fluid therapy on postoperative complications after thoracic surgery with one-lung ventilation: a systematic review and meta-analysis

Li,

Zhang,

Zhu

et al. 2023

World J Surg Onc

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“…In the context of esophageal surgery however, results are heterogeneous. Current evidence is insufficient to recommend enteral IN in patients undergoing esophagectomy and/or chemoradiotherapy for EC (45).…”

Section: Nutritionmentioning

confidence: 99%

Prehabilitation for esophagectomy

Doganay¹,

Moorthy²

2019

J. Thorac. Dis

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Esophagectomy remains the mainstay treatment of esophageal cancer (EC). Combined with neoadjuvant therapies, the management of EC has deleterious effects on body composition, functional capacity and psychological well-being. Preoperative patient optimisation known as prehabilitation is a novel intervention aimed at reducing morbidity and mortality associated with the trajectory of EC care. There is emerging evidence to suggest that prehabilitation is safe, feasible and efficacious. In addition, there is strong data to infer that prehabilitation has a positive effect on functional capacity through exercise. Nutritional and psychological interventions are less well evaluated. Furthermore, no convincing relationship between prehabilitation and oncological outcomes has been demonstrated. Early studies evaluating prehabilitation are promising however further large scale research is required in order to assess the clinical effectiveness.

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Enteral immunonutrition versus enteral nutrition for patients undergoing oesophagectomy: a systematic review and meta-analysis

Zhou

et al. 2020

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES According to retrospective studies, oesophageal carcinoma is the second deadliest gastrointestinal cancer after gastric cancer. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve the inflammatory response of patients undergoing oesophagectomy; however, conclusions across studies remain unclear. We aimed to evaluate the effect of EIN on the clinical and immunological outcomes of patients undergoing oesophagectomy. METHODS Four electronic databases (MEDLINE, Embase, Web of Science and Cochrane Library) were used to search articles in peer-reviewed, English-language journals. The mean difference, relative risk or standard mean difference with 95% confidence interval were calculated. Heterogeneity was assessed by the Cochran’s Q test and I2 statistic combined with the corresponding P-value. The analysis was carried out with RevMan 5.3. RESULTS Six articles were finally included, with a total of 320 patients with oesophageal cancer. The meta-analysis results showed that EIN did not improve clinical outcomes (such as infectious complications, pneumonia, surgical site infection, anastomotic leak and postoperative hospital stay) or immune indices [referring to C-reactive protein, interleukin (IL)-6, IL-8, tumour necrosis factor-α]. Descriptive analysis suggested that EIN also increased the serum concentrations of IgG and the percentage of the B-cell fraction. Thus, its impact on IL-8 and IL-6 remains inconsistent. CONCLUSIONS The early-stage impact of EIN on immunological status in patients undergoing oesophagectomy is still unclear. According to the results of this meta-analysis, whether EIN could improve the clinical outcomes or biological status after oesophagectomy compared to standard enteral nutrition is uncertain. Since the impact of EIN is unclear, current guidelines that strongly advise the use of EIN should be changed, as the utility of EIN is very uncertain. More appropriately powered clinical studies are warranted to confirm its effectiveness.

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Effects of Enteral Immunonutrition in Esophageal Cancer

Cited by 4 publications

References 42 publications

Effect of perioperative goal-directed fluid therapy on postoperative complications after thoracic surgery with one-lung ventilation: a systematic review and meta-analysis

Effect of perioperative goal-directed fluid therapy on postoperative complications after thoracic surgery with one-lung ventilation: a systematic review and meta-analysis

Prehabilitation for esophagectomy

Enteral immunonutrition versus enteral nutrition for patients undergoing oesophagectomy: a systematic review and meta-analysis

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