Preoperative immunonutrition in liver resection—a propensity score matched case-control analysis

Zacharias, Thomas; Ferreira, Nelio; Aj, Carin

doi:10.1038/ejcn.2014.113

Cited by 11 publications

(10 citation statements)

References 32 publications

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“…A Cochrane review by Koretz et al found no impact on postoperative mortality and morbidity for parenteral, enteral or oral nutritional support in surgery for liver disease [ 33 ]. In the authors’ institution during the study period preoperative nutritional support was mainly provided with oral immunonutrition [ 23 , 34 , 35 ], whereas postoperative nutritional support was mainly provided with parenteral nutrition [ 36 ]. The impact of nutritional support on outcome was not analyzed in the present study, as significant covariate imbalances were registered for patients with nutritional support versus those without nutritional support.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of nutritional support on outcome was not analyzed in the present study, as significant covariate imbalances were registered for patients with nutritional support versus those without nutritional support. The authors have reported a propensity score matched case-control analysis of preoperative immunonutrition versus no nutritional support in liver resection, and no benefit of preoperative immunonutrition with regard to postoperative complications could be demonstrated [ 35 ]. The impact of nutritional support on outcome should be analyzed in a randomized trial [ 33 , 34 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Nutritional risk screening 2002 and ASA score predict mortality after elective liver resection for malignancy

Zacharias¹,

Ferreira²

2017

aoms

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IntroductionThe aim of the study was to evaluate whether Nutritional risk screening 2002 (NRS 2002) at hospital admission may predict postoperative mortality and complications within 90 days after elective liver resection for malignancy.Material and methodsA retrospective cohort study of a prospective database was performed. Two-hundred and three patients with elective liver resection for malignancy between 9 November 2007 and 27 May 2014 were included. Clinical data, NRS 2002, surgical procedures and histology were recorded. The primary endpoint was 90-day mortality. Complications were registered within 90 days postoperatively according to the Clavien-Dindo classification.ResultsThe 90-day mortality was 5.9% and the overall complication rate was 59.1%. Multivariate analysis identified NRS 2002 score ≥ 4 (odds ratio (OR) = 9.24; p = 0.005) and American Society of Anesthesiologists (ASA) score ≥ 3 (OR = 6.20; p = 0.009) as predictors of 90-day mortality. The 90-day mortality was 27.6% (8/29) for patients with both risk factors (NRS 2002 score ≥ 4 and ASA score ≥ 3) vs. 2.3% (4/174) for patients without or with only one risk factor (p < 0.001).ConclusionsIn the present study NRS 2002 score ≥ 4 and ASA score ≥ 3 were predictors of 90-day mortality after elective liver resection for malignancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nutritional risk screening 2002 and ASA score predict mortality after elective liver resection for malignancy

Zacharias¹,

Ferreira²

2017

aoms

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“…They did not demonstrate an impact of pEN on postoperative complications after minor liver resection, which may be because of the absence of postoperative enteral nutrition. 17 …”

Section: Discussionmentioning

confidence: 99%

“… 12 The recent studies failed to confirm the effect of pEN on postoperative complications after liver resection. 16 , 17 Therefore, the authors investigated the effect of pEN on short-term outcomes in patients who underwent hepatectomy for HCC.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Enteral Nutritional Support in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

et al. 2015

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To compare the short-term outcomes between hepatocellular carcinoma (HCC) patients with and those without preoperative nutrition on the basis of postoperative enteral nutrition.HCC patients with postoperative enteral nutrition who underwent liver resection between February 2010 and December 2014 in Nanjing Drum Tower Hospital were considered for the study: 43 patients with and 36 patients without preoperative nutrition. Primary endpoint was the incidence of overall complications. Secondary endpoints were infectious and major complications.In the preoperative enteral nutrition group, shorter length of postoperative hospital stay (10.5 ± 2.7 versus 13.7 ± 6.3 days, P = 0.007), less exogenous albumin infusion (10.2 ± 22.4 versus 47.8 ± 97.7 g, P = 0.030), earlier first exhaust time (2.7 ± 0.8 versus 3.0 ± 0.9 days, P = 0.043), and first defection time (3.5 ± 0.9 versus 4.4 ± 1.4 days, P = 0.001) were observed. No significant differences were observed in the incidence of overall complications (32.6% versus 52.8%, P = 0.070), infectious complications (7.0% versus 8.3%, P = 1), and major complications (14.0% versus 11.1%, P = 0.969) between the preoperative enteral nutrition and control group.Preoperative enteral nutrition could improve short-term outcomes of HCC patients via accelerating the recovery of gastrointestinal function and shortening the length of postoperative hospital stay.

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“…Hepatectomy is the principal treatment for eligible patients with benign and malignant hepatobiliary diseases. Although improvements in operative techniques and perioperative management have markedly ameliorated the prognosis of patients undergoing hepatectomy [ 1 ], the rate of postoperative complications remains high, as shown by longer hospital stay and increased mortality [ 2 ]. Strategies are therefore needed to reduce the incidence of complications following hepatic resection.…”

Section: Introductionmentioning

confidence: 99%

The benefit of immunonutrition in patients undergoing hepatectomy: a systematic review and meta-analysis

et al. 2017

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Perioperative immunonutrition in liver resection remains doubtful. A systematic review and meta-analysis was conducted to compare postoperative outcomes between patients undergoing hepatectomy who received perioperative immunonutrition and those who did not.A PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Knowledge database search was performed to retrieve all of the randomized controlled trials (RCTs) evaluating the value of perioperative immunonutrition in patients undergoing hepatectomy until the end of September 2016. Data extraction and quality assessment of RCTs were performed in accordance with PRISMA guidelines. The quality of evidence for each postoperative outcome was assessed using the GRADEpro analysis. A random-effects model was used to conduct a meta-analysis with RevMan 5.3.5 software. Eight RCTs including 805 patients (402 with and 403 without immunonutrition) were identified. Immunonutrition, mainly ω-3 fatty acids, significantly reduced the incidence of postoperative total complications (risk ratio [RR] = 0.59; 95% confidence interval [CI], 0.46–0.75; p < 0.0001) and infectious complications (RR = 0.46; 95% CI, 0.32–0.68; p < 0.0001), and shortened the length of hospital stay (standardized mean difference, −0.49; 95% CI, −0.81 to −0.16; p = 0.0004). There was no significant between-group difference in postoperative mortality (RR = 0.46; 95% CI, 0.16–1.31; p = 0.15). Immunonutrition, mainly ω-3 fatty acids, is potentially beneficial in reducing overall and infectious postoperative complications and in shortening the hospital stay for patients undergoing hepatectomy.

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Preoperative immunonutrition in liver resection—a propensity score matched case-control analysis

Abstract: The present study did not permit to demonstrate an impact of preoperative immunonutrition with Oral-Impact on postoperative complications after minor liver resection.

Cited by 11 publications

References 32 publications

Nutritional risk screening 2002 and ASA score predict mortality after elective liver resection for malignancy

Nutritional risk screening 2002 and ASA score predict mortality after elective liver resection for malignancy

Preoperative Enteral Nutritional Support in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

The benefit of immunonutrition in patients undergoing hepatectomy: a systematic review and meta-analysis

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