The Impact of Preoperative Enteral Nutrition Enriched with Eicosapentaenoic Acid on Postoperative Hypercytokinemia after Pancreatoduodenectomy: The Results of a Double-Blinded Randomized Controlled Trial

Ashida, Ryo; Okamura, Yukiyasu; Wakabayashi‐Nakao, Kanako; Mizuno, Takashi; Aoki, Shuichi; Uesaka, Katsuhiko

doi:10.1159/000490110

Cited by 24 publications

(49 citation statements)

References 20 publications

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“…The study included 20 patients: 11 patients received preoperative IN (enteral diets enriched in eicosapentaenoic acid (EPA)) (Prosure; Abbot Japan Co., Ltd., Tokyo, Japan) in addition to 1200 kcal of regular food, and 9 patients were fed using an isocaloric isonitrogenous standard nutrition (600 kcal/day) without EPA (Procure Z; Nisshin Oillio Group, Ltd., Tokyo, Japan) for 7 days before surgery due to periampullary cancer. This study did not demonstrate the significant impact of preoperative IN on the rates of postoperative hypercytokinemia or infectious complications in 50 patients following PD [28].…”

Section: The Use Of In In Patients Undergoing Pd In the Recent World contrasting

confidence: 67%

“…Ashida et al [28] analyzed the impact of IN on the incidence of hypercytokinemia after PD in a double-blinded randomized controlled trial. The study included 20 patients: 11 patients received preoperative IN (enteral diets enriched in eicosapentaenoic acid (EPA)) (Prosure; Abbot Japan Co., Ltd., Tokyo, Japan) in addition to 1200 kcal of regular food, and 9 patients were fed using an isocaloric isonitrogenous standard nutrition (600 kcal/day) without EPA (Procure Z; Nisshin Oillio Group, Ltd., Tokyo, Japan) for 7 days before surgery due to periampullary cancer.…”

Section: The Use Of In In Patients Undergoing Pd In the Recent World mentioning

confidence: 99%

“…In order to decrease the risk of postoperative infectious complications in patients undergoing PD, the production of these cytokines should be decreased. IN may suppress postoperative hypercytokinemia and reduce the rate of infectious complications following PD, which is associated with a shorter duration of hospitalization [28]. It has been shown that PD is one of the most stressful surgeries.…”

Section: Immunomodulating Mechanisms Of Nutrients Used In Inmentioning

confidence: 99%

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The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy

Jabłońska

Mrowiec

2020

Nutrients

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Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgical procedures in abdominal surgery. Malnutrition and immune dysfunction in patients with pancreatic cancer (PC) may lead to a higher risk of postoperative infectious complications. Although immunonutrition (IN) is recommended for enhanced recovery after surgery (ERAS) in patients undergoing PD for 5–7 days perioperatively, its role in patients undergoing pancreatectomy is still unclear and controversial. It is known that the proper surgical technique is very important in order to reduce a risk of postoperative complications, such as a pancreatic fistula, and to improve disease-free survival in patients following PD. However, it has been proven that IN decreases the risk of infectious complications, and shortens hospital stays in patients undergoing PD. This is a result of the impact on altered inflammatory responses in patients with cancer. Both enteral and parenteral, as well as preoperative and postoperative IN, using various nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides, is administered. The most frequently used preoperative oral supplementation is recommended. The aim of this paper is to present the indications and benefits of IN in patients undergoing PD.

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Section: The Use Of In In Patients Undergoing Pd In the Recent World contrasting

confidence: 67%

Section: The Use Of In In Patients Undergoing Pd In the Recent World mentioning

confidence: 99%

Section: Immunomodulating Mechanisms Of Nutrients Used In Inmentioning

confidence: 99%

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The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy

Jabłońska

Mrowiec

2020

Nutrients

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“…The first double-blinded RCT (Ashida et al 20 ) was conducted to compare outcomes between the control group (standard nutrition, n = 9) and the treatment group (preoperative eicosapentaenoic acid-enriched nutrition, n = 11) after PD. There were no significant differences in perioperative interleukin-6 levels between the two groups (P = .68).…”

Section: Immunonutritionmentioning

confidence: 99%

Current evidence of nutritional therapy in pancreatoduodenectomy: Systematic review of randomized controlled trials

Takagi

Domagała

Hartog

et al. 2019

Annals of Gastroent Surgery

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Aim: Evidence of nutritional therapies in pancreatoduodenectomy (PD) has been shown. However, few studies focus on the association between different nutritional therapies and outcomes. The aim of this review was to summarize the current evidence of nutritional therapies such as enteral nutrition (EN), immunonutrition, and synbiotics on postoperative outcomes after PD. Methods:A systematic literature search of Embase, Medline Ovid, and Cochrane CENTRAL was done to summarize the available evidence, including randomized controlled trials, meta-analyses and reviews, regarding nutritional therapy in PD. Results:A total of 20 randomized controlled trials were included in this review. Safety and tolerability of EN in PD was shown. Giving postoperative EN can shorten length of stay compared to parenteral nutrition; however, the effect of EN on postoperative complications remains controversial. Postoperative EN should be given only on selective indications rather than routinely used, and preoperative EN is indicated only in patients with severe malnutrition. Giving preoperative immunonutrition is considered to reduce the incidence of infectious complications; however, evidence level is moderate and recommendation grade is weak. The beneficial effect of perioperative synbiotics on postoperative infectious complications is limited. Furthermore, the effectiveness of other nutritional supplements remains unclear. Conclusion:Recently, evidence of enhanced recovery after surgery (ERAS) in PD has been increasing. Early oral intake with systematic nutritional support is an important aspect of the ERAS concept. Future well-designed studies should investigate the impact of systematic nutritional therapies on outcomes following PD. K E Y W O R D Senteral nutrition, immunonutrition, nutritional intervention, pancreatoduodenectomy, synbiotics | 621 TAKAGI eT Al.

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“…However, the nutritional status did not change the major morbidity or mortality rate. These results are credible because the recent RCTs failed in demonstrating the role of preoperative nutritional support in reducing major complications or mortality after PD [23,24]. It is reasonable to assume that, in pancreatic surgery, the 90-days mortality or major morbidity rate could depend mainly on comorbidity presence, ASA score, technical aspects such as the type of surgery (PD vs. DP or vascular resection) or type of disease (PDAC vs. non-PDAC) [25].…”

Section: Discussionmentioning

confidence: 93%