Immunoenhancing Enteral and Parenteral Nutrition for Gastrointestinal Surgery

Mazaki, Takero; Ishii, Yoshinori; Murai, Ichiro

doi:10.1097/sla.0000000000000935

Cited by 50 publications

(31 citation statements)

References 38 publications

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“…Optimal timing of the immunonutritional intervention may be important. Generally, preoperative immunonutritional intervention is thought to be beneficial for patients undergoing GI surgery [25]. However, no available studies have discussed when to initiate and for how long to maintain an immunonutritional intervention for patients receiving pCRT for the treatment of rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Immunonutritional Status Changes During Preoperative Chemoradiation in Patients With Rectal Cancer

et al. 2016

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PurposePrevious studies have demonstrated the prognostic impact of the prognostic nutritional index (PNI), a proposed indicator of immunonutritional statuses of surgical patients, on patients with various gastrointestinal cancers. Although the prognostic impact of the PNI on patients with colorectal cancer has been well established, its value has not been studied in patients treated with preoperative chemoradiation (pCRT). This study aimed to evaluate the prognostic impact of PNI on patients receiving pCRT for locally advanced rectal cancer (LARC).MethodsPatients with LARC who underwent curative pCRT followed by surgical resection were enrolled. The PNI was measured in all patients before and after pCRT, and the difference in values was calculated as the PNI difference (dPNI). Patients were classified according to dPNI (<5, 5–10, and >10). Clinicopathologic parameters and long-term oncologic outcomes were assessed according to dPNI classification.ResultsNo significant intergroup differences were observed in clinicopathologic parameters such as age, histologic grade, tumor location, tumor-node-metastasis stage, and postoperative complications. Approximately 53% of the patients had a mild dPNI (<5); only 15% had a high dPNI (>10). Univariate and multivariate analyses identified the dPNI as an independent prognostic factor for disease-free status (P < 0.01; hazard ratio [HR], 2.792; 95% confidence interval [CI], 1.577–4.942) and for cancer-specific survival (P = 0.012; HR, 2.469; 95%CI, 1.225–4.978).ConclusionThe dPNI is predictive of long-term outcomes in pCRT-treated patients with LARC. Further prospective studies should investigate whether immune-nutritional status correction during pCRT would improve oncologic outcomes.

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Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Immunonutritional Status Changes During Preoperative Chemoradiation in Patients With Rectal Cancer

et al. 2016

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“…Of note, even if ERAS is nowadays a standard of care in the institution where the present analysis was conducted, the perioperative care pathway was not yet standardized at the time of trial initiation. The beneficial effect of preoperative nutritional support on postoperative outcome has been widely investigated and is strongly recommended in major abdominal surgeries [1] . The present results suggest close nutritional follow-up beyond the postoperative phase, especially when confronted with postoperative complications, and need to be considered an argument for appropriate nutritional care and follow-up even within an ERAS program.…”

Section: Discussionmentioning

confidence: 99%

“…Then, energy and protein gaps were calculated by comparing effective energy and protein intake with energy and protein needs. Appetite and food intake compared to the situation before the illness occurred (baseline food intake) were assessed with a visual analogue scale (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Pre-and Postoperative Evaluation Of Nutritional Risk and Nutmentioning

confidence: 99%

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Nutritional Status Deteriorates Postoperatively Despite Preoperative Nutritional Support

Grass¹,

Benoit²,

Bertrand

et al. 2016

Ann Nutr Metab

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Background/Aims: The aim of the current study was to assess the postoperative evolution of nutritional status and to relate it with postoperative outcomes. Methods: Demographic, surgical and nutritional parameters were assessed 10 days preoperatively (d-10) and 30 days postoperatively (d30) in 146 patients. Risk factors responsible for perioperative (>5% between d-10 and d30) weight loss were identified. Overall, severe (Clavien 3-5) and infectious complications were compared in patients with and without perioperative weight loss (>5%). Results: Nutritional status worsened beyond the postoperative period as reflected by decreasing weight (67 ± 13 kg at d-10 vs. 63 ± 13 kg at d30, p < 0.001), body mass index (23.4 ± 4 vs. 22.2 ± 4 kg/m², p < 0.001) and mid upper-arm muscle circumference (MAMC, 241 ± 32 vs. 232 ± 30 mm, p < 0.001). Fifty-two patients (46%) lost >5% of their body weight between d-10 and d30. Patients who presented overall (63 vs. 36%, p = 0.004) and major (27 vs. 10%, p = 0.016) postoperative complications were at significantly higher risk to deteriorate postoperative nutritional status. Multivariate analysis identified low preoperative lean body mass (OR 3.2; 95% CI 1.2-8.9, p = 0.023) and low preoperative MAMC (OR 2.5; 95% CI 0.9-6.8, p = 0.066) as independent risk factors for perioperative weight loss. Conclusions: These data suggest continuing nutritional follow-up after the index hospitalization.

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“…Several studies have shown that preoperative nutritional intervention may reduce the incidence of postoperative morbidities (16,17). However, no studies to date showed that these nutritional interventions could improve long-term outcomes after esophagectomy.…”

mentioning

confidence: 99%

Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy

Yoshida

Baba

2017

J. Thorac. Dis.

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Immunoenhancing Enteral and Parenteral Nutrition for Gastrointestinal Surgery

Abstract: This study suggests that IMEN outperformed other nutrition types for reducing complications and IMEN should be considered the best available option.

Cited by 50 publications

References 38 publications

Prognostic Impact of Immunonutritional Status Changes During Preoperative Chemoradiation in Patients With Rectal Cancer

Prognostic Impact of Immunonutritional Status Changes During Preoperative Chemoradiation in Patients With Rectal Cancer

Nutritional Status Deteriorates Postoperatively Despite Preoperative Nutritional Support

Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy

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