Perioperative immunonutrition in normo-nourished patients undergoing laparoscopic colorectal resection

Moya, Pedro; Miranda, Elena; Soriano-Irigaray, Leticia; Arroyo, Antonio; Aguilar, M M Quintana; Bellón, Marta; Muñoz, José Luis; Candela, Fernando; Calpena, Rafael

doi:10.1007/s00464-016-4836-7

Cited by 55 publications

(44 citation statements)

References 33 publications

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“…82 In a separate study of IMN compared to dietary advice without supplementation by the same authors, wound infection rates in laparoscopic colectomy were significantly reduced with the use of IMN (11.5% vs 0%; P = .006). 83 A major real-world quality improvement effort using preoperative IMN in 3375 patients in Washington state demonstrated a reduction of 23% in the number of patients with a prolonged LOS (P = .05) in a covariate-matched analysis. 84 The POQI-2 group was divided regarding the strength of their recommendation for IMN.…”

Section: Role Of Perioperative Imnmentioning

confidence: 98%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Wischmeyer

Carli

Evans

et al. 2018

Anesthesia &Amp; Analgesia

337

327

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Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.

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Section: Role Of Perioperative Imnmentioning

confidence: 98%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Wischmeyer

Carli

Evans

et al. 2018

Anesthesia &Amp; Analgesia

337

327

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“…Most studies had a clear description of their random sequence generation. Three studies used a computer random number generator [ 28 – 30 ], one used an envelope [ 25 ], two used the web-based randomization [ 23 , 24 ], and three studies did not give the sufficient information [ 26 , 27 , 31 ]. Among them, three studies appropriately performed the allocation concealment [ 23 – 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…The remaining studies had no sufficient information about blinding. Two studies reported the drop-out before conducting the immunonutrition [ 24 , 30 ]; therefore, corresponding domain was graded as “low risk.” All nine included studies showed the pre-specified outcomes in the pre-specified way. The assessment of risk of bias outcome of each study is summarized in Tables 3 and 4 .…”

Section: Resultsmentioning

confidence: 99%

Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis

Sun

Xin

et al. 2018

Int J Colorectal Dis

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PurposeImmunonutrition has been used to prevent the complications after colorectal elective surgery. This systematic review aimed to analyze and assess the effect of immunonutrition on colorectal cancer patients who received elective surgery.MethodsThree electronic databases (Medline, Embase, Cochrane) were used to search the latent studies which investigated the effects of enteral immunonutrition (EIN) compared with standard enteral nutrition (EN) or parenteral immunonutrition (PIN) compared with standard parenteral nutrition (PN) on colorectal cancer patients who are undergoing surgery until 21st of April, 2017. Meta-analysis was conducted to calculate odd risk (OR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI), and heterogeneity was tested by Q test.ResultsNine publications were included. The meta-analysis results presented that EIN improved the length of hospital stay (pooled MD, 2.53; 95% CI, 1.29–3.41), infectious complications (pooled OR, 0.33; 95% CI, 0.21–0.53) which contains the Surgical Site Infections (pooled OR, 0.25; 95% CI, 0.22–0.58) and Superficial/Deep incisional infections (pooled OR, 0.27; 95% CI, 0.12–0.64); meanwhile, PIN improved the length of hospital stay (pooled MD, 2.66; 95% CI, 0.62–4.76), IL-6 (pooled MD, − 6.09; 95% CI, − 10.11 to − 2.07), CD3 (pooled MD, 7.50; 95% CI, 3.57–11.43), CD4 (pooled MD, 5.47; 95% CI, 2.54–8.40), and CD4/CD8 (pooled MD, 0.50; 95% CI, 0.22–0.78); the level of CD8 was lower (pooled MD, − 4.32; 95% CI, − 7.09 to − 1.55) in PIN.ConclusionImmunonutrition could be an effective approach to enhance the immune function of colorectal cancer patients undergoing elective surgery and to improve the clinical and laboratory outcomes.Electronic supplementary materialThe online version of this article (10.1007/s00384-017-2958-6) contains supplementary material, which is available to authorized users.

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“…Micronutrients have been shown to be important in the perioperative period, and there are some vitamins and minerals which may be deficient particularly in older people . It is also of note that ONSs supplemented with immune‐enhancing agents administered pre‐operatively have resulted in a reduction in infections in patients with colorectal cancer …”

Section: Discussionmentioning

confidence: 99%

“…32 It is also of note that ONSs supplemented with immuneenhancing agents administered pre-operatively have resulted in a reduction in infections in patients with colorectal cancer. 33 People with colorectal cancer lose weight due to symptom load, psychological distress, and adjuvant treatment effects. 34 Weight loss in the perioperative period influences people's lives during recovery and post-operative rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Pre‐operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight‐losing patients with colorectal cancer: single‐blind randomized controlled trial

Burden

Gibson

Lal

et al. 2017

J cachexia sarcopenia muscle

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BackgroundPre‐operative weight loss has been consistently associated with increased post‐operative morbidity. The study aims to determine if pre‐operative oral nutritional supplements (ONSs) with dietary advice reduce post‐operative complications.MethodsSingle‐blinded randomized controlled trial. People with colorectal cancer scheduled for surgery with pre‐operative weight loss >1 kg/3–6 months were randomized by using stratified blocks (1:1 ratio) in six hospitals (1 November 2013–28 February 2015). Intervention group was given 250 mL/day ONS (10.1 KJ and 0.096 g protein per mL) and dietary advice. Control group received dietary advice alone. Oral nutritional supplements were administered from diagnosis to the day preceding surgery. Research team was masked to group allocation. Primary outcome was patients with one or more surgical site infection (SSI) or chest infection; secondary outcomes included percentage weight loss, total complications, and body composition measurements. Intention‐to‐treat analysis was performed with both unadjusted and adjusted analyses. A sample size of 88 was required.ResultsOf 101 participants, (55 ONS, 46 controls) 97 had surgery. In intention‐to‐treat analysis, there were 21/45 (47%) patients with an infection—either an SSI or chest infection in the control group vs. 17/55 (30%) in the ONS group. The odds ratio of a patient incurring either an SSI or chest infection was 0.532 (P = 0.135 confidence interval 0.232 to 1.218) in the unadjusted analysis and when adjusted for random differences at baseline (age, gender, percentage weight loss, and cancer staging) was 0.341 (P = 0.031, confidence interval 0.128 to 0.909). Pre‐operative percentage weight loss at the first time point after randomization was 4.1% [interquartile range (IQR) 1.7–7.0] in ONS group vs. 6.7% (IQR 2.6–10.8) in controls (Mann–Whitney U P = 0.021) and post‐operatively was 7.4% (IQR 4.3–10.0) in ONS group vs. 10.2% (IQR 5.1–18.5) in controls (P = 0.016).ConclusionsCompared with dietary advice alone, ONS resulted in patients having fewer infections and less weight loss following surgery for colorectal cancer. We have demonstrated that pre‐operative oral nutritional supplementation can improve clinical outcome in weight losing patients with colorectal cancer.

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Perioperative immunonutrition in normo-nourished patients undergoing laparoscopic colorectal resection

Abstract: This study is registered with ClinicalTrial.gov : NCT0239396.

Cited by 55 publications

References 33 publications

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis

Pre‐operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight‐losing patients with colorectal cancer: single‐blind randomized controlled trial

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