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BMC Gastroenterology
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Open Access 01-12-2024 | Systematic Review

Impact of perioperative immunonutrition on postoperative outcomes in pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials

Authors: Gaofeng Zhang, Bing Zhao, Tengang Deng, Xiaofei He, Yongpin Chen, Changtao Zhong, Jie Chen

Published in: BMC Gastroenterology | Issue 1/2024

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Abstract

Background

This systematic review and meta-analysis aimed to evaluate the impact of perioperative immunonutrition on postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD).

Methods

Conducted a comprehensive search in PubMed, Embase, Cochrane Library, Medline, and Web of Science databases to identify all randomized controlled trials (RCTs) on the topic of immunonutrition and PD. Subsequently screened literature, extracted data, and assessed the risk of bias in the included studies, and finally conducted a meta-analysis using RevMan 5.3 software.

Results

The analysis included a total of 10 RCTs with 574 patients, among whom 288 were in the immunonutrition group and 283 in the control group. The meta-analysis revealed a significantly lower incidence of postoperative infection-related complications (OR = 0.45; 95% CI: 0.27–0.74; P = 0.002) and severe postoperative complications (OR = 0.61; 95% CI: 0.38–0.98; P = 0.04) in the immunonutrition group compared to the control group. Additionally, patients in the immunonutrition group had a significantly shorter length of hospital stay (MD= -1.87; 95%CI -3.29 - -0.44; P = 0.01). However, the analysis revealed no statistically significant difference in the overall complication rate between the two groups (P = 0.67). Furthermore, the incidence of specific complications and perioperative mortality rates also did not demonstrate any statistically significant differences (all P > 0.05).

Conclusions

Perioperative immunonutrition in PD patients can reduce postoperative infection-related complications, but more high-quality RCTs are needed for further validation.
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Literature
1.
2.
Xiang Y, Wu J, Lin C, Yang Y, Zhang D, Xie Y, et al. Pancreatic reconstruction techniques after pancreaticoduodenectomy: a review of the literature. Expert Rev Gastroenterol Hepatol. 2019;13:797–806.CrossRefPubMed
3.
Kokkinakis S, Kritsotakis EI, Maliotis N, Karageorgiou I, Chrysos E, Lasithiotakis K. Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int. 2022;21(6):527-537.
4.
Pappas S, Krzywda E, McDowell N. Nutrition and pancreaticoduodenectomy. Nutr Clin Pract. 2010;25:234–43.CrossRefPubMed
5.
Di Carlo V, Gianotti L, Balzano G, Zerbi A, Braga M. Complications of pancreatic surgery and the role of Perioperative Nutrition. Dig Surg. 1999;16:320–6.CrossRefPubMed
6.
Melloul E, Lassen K, Roulin D, Grass F, Perinel J, Adham M, et al. Guidelines for Perioperative Care for Pancreatoduodenectomy: enhanced recovery after surgery (ERAS) recommendations 2019. World J Surg. 2020;44:2056–84.CrossRefPubMed
7.
8.
9.
Kavalukas S, McClave SA. Immunonutrition vs standard nutrition for patients with cancer. Nutr Clin Pract. 2023;38:924–31.CrossRefPubMed
10.
Grimm H, Kraus A. Immunonutrition–supplementary amino acids and fatty acids ameliorate immune deficiency in critically ill patients. Langenbecks Arch Surg. 2001;386:369–76.CrossRefPubMed
11.
Mc MC. M. The role of Immunonutrition in patients. Nutrients. 2023;15.
12.
Zapatera B, Prados A, Gómez-Martínez S, Marcos A. Immunonutrition: methodology and applications. Nutr Hosp. 2015;31(Suppl 3):145–54.PubMed
13.
Cerantola Y, Hübner M, Grass F, Demartines N, Schäfer M. Immunonutrition in gastrointestinal surgery. Br J Surg. 2011;98:37–48.CrossRefPubMed
14.
Shen J, Dai S, Li Z, Dai W, Hong J, Huang J, et al. Effect of Enteral Immunonutrition in patients undergoing surgery for gastrointestinal Cancer: an updated systematic review and Meta-analysis. Front Nutr. 2022;9:941975.CrossRefPubMedPubMedCentral
15.
Miyauchi Y, Furukawa K, Suzuki D, Yoshitomi H, Takayashiki T, Kuboki S, et al. Additional effect of perioperative, compared with preoperative, immunonutrition after pancreaticoduodenectomy: a randomized, controlled trial. Int J Surg. 2019;61:69–75.CrossRefPubMed
16.
Aida T, Furukawa K, Suzuki D, Shimizu H, Yoshidome H, Ohtsuka M, et al. Preoperative immunonutrition decreases postoperative complications by modulating prostaglandin E2 production and T-cell differentiation in patients undergoing pancreatoduodenectomy. Surgery. 2014;155:124–33.CrossRefPubMed
17.
Guan H, Chen S, Huang Q. Effects of Enteral Immunonutrition in patients undergoing pancreaticoduodenectomy: a Meta-analysis of Randomized controlled trials. Ann Nutr Metab. 2019;74:53–61.CrossRefPubMed
18.
Ashida R, Okamura Y, Wakabayashi-Nakao K, Mizuno T, Aoki S, Uesaka K. The Impact of Preoperative Enteral Nutrition Enriched with eicosapentaenoic acid on postoperative hypercytokinemia after pancreatoduodenectomy: the results of a double-blinded Randomized Controlled Trial. Dig Surg. 2019;36:348–56.CrossRefPubMed
19.
Mj P, Je M, Pm B, Tc IB, Cd H. M, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg (London England). 2021;88.
20.
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefPubMedPubMedCentral
21.
22.
Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27:1785–805.CrossRefPubMed
23.
Gianotti L, Braga M, Gentilini O, Balzano G, Di Zerbi A. Carlo V Artif Nutr after Pancreaticoduodenectomy: Pancreas. 2000;21:344–51.
24.
Tumas J, Jasiūnas E, Strupas K, Šileikis A. Effects of Immunonutrition on Comprehensive Complication Index in patients undergoing pancreatoduodenectomy. Medicina. 2020;56:52.CrossRefPubMedPubMedCentral
25.
Suzuki D, Furukawa K, Kimura F, Shimizu H, Yoshidome H, Ohtsuka M, et al. Effects of perioperative immunonutrition on cell-mediated immunity, T helper type 1 (Th1)/Th2 differentiation, and Th17 response after pancreaticoduodenectomy. Surgery. 2010;148:573–81.CrossRefPubMed
26.
Jo S, Choi S, Heo J, Kim E, Min M, Choi D, et al. Missing effect of glutamine supplementation on the Surgical Outcome after Pancreaticoduodenectomy for Periampullary tumors: a prospective, randomized, Double-blind, controlled clinical trial. World j surg. 2006;30:1974–82.CrossRefPubMed
27.
Hamza N, Darwish A, O’Reilly DA, Denton J, Sheen AJ, Chang D, et al. Perioperative Enteral Immunonutrition modulates systemic and mucosal immunity and the inflammatory response in patients with Periampullary Cancer Scheduled for Pancreaticoduodenectomy: a Randomized Clinical Trial. Pancreas. 2015;44:41–52.CrossRefPubMed
28.
Gade J, Levring T, Hillingsø J, Hansen CP, Andersen JR. The effect of preoperative oral immunonutrition on complications and length of Hospital stay after elective surgery for pancreatic Cancer–A Randomized Controlled Trial. Nutr Cancer. 2016;68:225–33.CrossRefPubMed
29.
Afaneh C, Gerszberg D, Slattery E, Seres DS, Chabot JA, Kluger MD. Pancreatic cancer surgery and nutrition management: a review of the current literature. Hepatobiliary Surg Nutr. 2015;4:59–71.PubMedPubMedCentral
30.
Poulia KA, Sarantis P, Antoniadou D, Koustas E, Papadimitropoulou A, Papavassiliou AG, et al. Pancreatic Cancer and Cachexia-metabolic mechanisms and Novel insights. Nutrients. 2020;12:1543.CrossRefPubMedPubMedCentral
31.
Long Z-D, Lu C, Xia X-G, Chen B, Xing Z-X, Bie L, et al. Personal predictive model based on systemic inflammation markers for estimation of postoperative pancreatic fistula following pancreaticoduodenectomy. World J Gastrointest Surg. 2022;14:963–75.CrossRefPubMedPubMedCentral
32.
Giger U, Büchler M, Farhadi J, Berger D, Hüsler J, Schneider H, et al. Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery-a randomized controlled pilot study. Ann Surg Oncol. 2007;14:2798–806.CrossRefPubMed
33.
Jotheeswaran R, Singh H, Kaur J, Nada R, Yadav TD, Gupta V, et al. Role of inflammatory and nutritional markers in predicting complications after pancreaticoduodenectomy. Surgery. 2022;172:1502–9.CrossRefPubMed
34.
Karagianni VT, Papalois AE, Triantafillidis JK. Nutritional status and nutritional support before and after pancreatectomy for pancreatic cancer and chronic pancreatitis. Indian J Surg Oncol. 2012;3:348–59.CrossRefPubMedPubMedCentral
35.
Xu X, Zheng C, Zhao Y, Chen W, Huang Y. Enhanced recovery after surgery for pancreaticoduodenectomy: review of current evidence and trends. Int J Surg. 2018;50:79–86.CrossRefPubMed
36.
Wu G, Meininger CJ, Knabe DA, Bazer FW, Rhoads JM. Arginine nutrition in development, health and disease. Curr Opin Clin Nutr Metab Care. 2000;3:59–66.CrossRefPubMed
37.
Efron DT, Barbul A. Modulation of inflammation and immunity by arginine supplements. Curr Opin Clin Nutr Metab Care. 1998;1:531–8.CrossRefPubMed
38.
39.
Cruzat V, Macedo Rogero M, Noel Keane K, Curi R, Newsholme P. Glutamine: metabolism and Immune function, supplementation and clinical translation. Nutrients. 2018;10:E1564.CrossRef
40.
Shahidi F, Ambigaipalan P. Omega-3 polyunsaturated fatty acids and their health benefits. Annu Rev Food Sci Technol. 2018;9:345–81.CrossRefPubMed
41.
Kepp O, Loos F, Liu P, Kroemer G. Extracellular nucleosides and nucleotides as immunomodulators. Immunol Rev. 2017;280:83–92.CrossRefPubMed
42.
de Toro-Martín J, Arsenault BJ, Després J-P, Vohl M-C. Precision Nutrition: a review of Personalized Nutritional approaches for the Prevention and Management of metabolic syndrome. Nutrients. 2017;9:913.CrossRefPubMedPubMedCentral
43.
Fan Y, Li N, Zhang J, Fu Q, Qiu Y, Chen Y. The Effect of immunonutrition in patients undergoing pancreaticoduodenectomy: a systematic review and meta-analysis. BMC Cancer. 2023;23:351.CrossRefPubMedPubMedCentral
Metadata
Title
Impact of perioperative immunonutrition on postoperative outcomes in pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials
Authors
Gaofeng Zhang
Bing Zhao
Tengang Deng
Xiaofei He
Yongpin Chen
Changtao Zhong
Jie Chen
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2024
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-024-03510-6

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