TABLE 2 - uploaded by Luigi Marano
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Enteral immunodiet has been gaining increasing attention, but experimental data of its clinical effects in patients with gastric cancer are inconsistent, contradictory, and poorly investigated. The aim of this study was to assess the impact of early postoperative enteral immunonutrition on clinical and immunological outcomes in a homogeneous group...
Context in source publication
Context 1
... shown in Table 2, the duration of SIRS in the IED group (1.1 ± 0.89 days) was significantly shorter than that in the SEN group (2.2 ± 1.02 days, p = .036). The inci- dence of infectious complications and the anastomotic leak rate were found to be statistically significantly reduced in the immunoenriched diet group. ...
Citations
... An immunonutrition therapy using either arginine, n-3 omega fatty acids, or glutamine has been developed and used clinically to reduce Table 1 summarizes the characteristics of the 23 studies included in the quantitative synthesis. Of these studies, 10 were for esophageal cancer [11][12][13]16,17,21,29,[31][32][33], 7 were for gastric cancer [14,15,[18][19][20]23], and 6 were for mixed upper GI [22,24,25,27,28,30]. Regarding the nutritional intervention timing, 5 studies were conducted preoperatively [16,20,23,24,33], 8 were postoperatively [15,17,19,22,[25][26][27]31], and 10 were preoperatively and postoperatively [11][12][13][14]18,21,28,29,31,32]. ...
... Table 1 summarizes the characteristics of the 23 studies included in the quantitative synthesis. Of these studies, 10 were for esophageal cancer [11][12][13]16,17,21,29,[31][32][33], 7 were for gastric cancer [14,15,[18][19][20]23], and 6 were for mixed upper GI [22,24,25,27,28,30]. Regarding the nutritional intervention timing, 5 studies were conducted preoperatively [16,20,23,24,33], 8 were postoperatively [15,17,19,22,[25][26][27]31], and 10 were preoperatively and postoperatively [11][12][13][14]18,21,28,29,31,32]. ...
... Of these studies, 10 were for esophageal cancer [11][12][13]16,17,21,29,[31][32][33], 7 were for gastric cancer [14,15,[18][19][20]23], and 6 were for mixed upper GI [22,24,25,27,28,30]. Regarding the nutritional intervention timing, 5 studies were conducted preoperatively [16,20,23,24,33], 8 were postoperatively [15,17,19,22,[25][26][27]31], and 10 were preoperatively and postoperatively [11][12][13][14]18,21,28,29,31,32]. We did not find any literature that included only patients with malnutrition. ...
There is no consensus on the efficacy of perioperative immunonutrition in patients with upper gastrointestinal (GI) cancer surgery. We clarified the impact of perioperative immunonutrition on postoperative outcomes in patients with upper GI cancers. We searched MEDLINE (PubMed), MEDLINE (OVID), EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Selection, and Emcare from 1981–2022 using search terms related to immunonutrition and upper GI cancer. We included randomized controlled trials. Intervention was defined as immunonutritional therapy, including arginine, n-3 omega fatty acids, or glutamine during the perioperative period. The control was defined as standard nutritional therapy. The primary outcomes were infectious complications, defined as events with a Clavien–Dindo classification grade ≥ II that occurred within 30 days after surgery. After screening, 23 studies were included in the qualitative synthesis and in the quantitative synthesis. The meta-analysis showed that immunonutrition reduced infectious complications (relative risk ratio: 0.72; 95% confidence interval: 0.57–0.92; certainty of evidence: Moderate) compared with standard nutritional therapy. In conclusion, nutritional intervention with perioperative immunonutrition in patients with upper GI cancers significantly reduced infectious complications. The effect of immunonutrition for upper GI cancers in reducing the risk of infectious complications was about 30%.
... Moreover, nutritional status was assessed throughout the duration of cancer treatments in 55.6% of cases. Cancer-related malnutrition is very common among patients affected by solid malignancies, with a high percentage of patients experiencing malnutrition during the course of their disease due to several reasons, including the type of tumor, the disease stage and the type of treatment (e.g., surgery, chemotherapy, concomitant RT-CT, etc.) (39)(40)(41). Thus, it is mandatory to identify cancer patients at nutritional risk as a component of a proper, comprehensive care (42). ...
... Recently, this effect has been studied especially in patients with malnutrition and it was observed that diets rich in n-3 fatty acids, arginine, glutamine, and vitamins C and E improve clinical outcomes including infections, inflammation, and complications that occur in patients after surgery or trauma (Klek et al., 2011;Marano et al., 2013). In accordance with previous literature, our enriched low-DII formula with anti-inflammatory properties may affect this process in critically ill patients by increasing the intake of dietary antioxidants. ...
In traumatic brain injury (TBI) patients, a complex cascade of inflammatory responses are frequently observed following trauma. Numerous dietary agents have long been found to have potential in modulating inflammatory responses. This pilot study, designed an enteral formula with low inflammatory properties based on the dietary inflammatory index (DII®) and evaluated its effect on inflammatory and metabolic factors in critically ill TBI patients. This single-blind randomized controlled pilot study was conducted at the Neurosurgical ICU of Shahid Kamyab Hospital (Mashhad, Iran). A total of 20 TBI patients were randomly assigned to receive either low-DII score or standard formula at the intensive care unit (ICU). The primary outcomes of the study included clinical status, inflammatory biomarkers, APACHE II, SAPS II, SOFA, and NUTRIC scores. The trial groups did not differ significantly in baseline values. Following 14 days of intervention, there was a statistically significant decrease in the APACHE II, SAPS II, and NUTRIC scores and a significant increase in the GCS score in the low-DII score formula group compared to the standard formula group. Over 2 weeks, high sensitivity C-reactive protein (hs-CRP) values of −2.73 (95% CI: −3.67,
... However, non-infectious complications are typically associated with factors such as the surgery itself, anesthesia, and other factors, which are not directly related to immune function. Similar to certain studies after resection of gastrointestinal cancer [38,39], IMN may significantly reduce the risk of infectious complications following PD. However, its impact on non-infectious complications, such as POPF and DGE, appears to be insignificant. ...
Background
Pancreaticoduodenectomy (PD) is a complex and traumatic abdominal surgery with a high risk of postoperative complications. Nutritional support, including immunonutrition (IMN) with added glutamine, arginine, and ω-3 polyunsaturated fatty acids, can improve patients’ prognosis by regulating postoperative inflammatory response. However, the effects of IMN on PD patients’ outcomes require further investigation.
Methods
PMC, EMbase, web of science databases were used to search literatures related to IMN and PD. Data such as length of hospital stay, infectious complications, non-infectious complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), mortality, systemic inflammatory response syndrome (SIRS) duration, IL-6, and C-reactive protein (CRP) were extracted, and meta-analyses were performed on these data to study their pooled results, heterogeneity, and publication bias.
Results
This meta-analysis involved 10 studies and a total of 572 patients. The results showed that the use of IMN significantly reduced the length of hospital stay for PD patients (MD = -2.31; 95% CI = -4.43, -0.18; P = 0.03) with low heterogeneity. Additionally, the incidence of infectious complications was significantly reduced (MD = 0.42; 95% CI = 0.18, 1.00, P = 0.05), with low heterogeneity after excluding one study. However, there was no significant impact on non-infectious complications, the incidence of POPF and DGE, mortality rates, duration of SIRS, levels of IL-6 and CRP.
Conclusion
The use of IMN has been shown to significantly shorten hospital stays and decrease the frequency of infectious complications in PD patients. Early implementation of IMN is recommended for those undergoing PD. However, further research is needed to fully assess the impact of IMN on PD patients through larger and higher-quality studies.
... Moreover, nutritional status was assessed throughout the duration of cancer treatments in 55.6% of cases. Cancer-related malnutrition is very common among patients affected by solid malignancies, with a high percentage of patients experiencing malnutrition during the course of their disease due to several reasons, including the type of tumor, the disease stage and the type of treatment (e.g., surgery, chemotherapy, concomitant RT-CT, etc.) (39)(40)(41). Thus, it is mandatory to identify cancer patients at nutritional risk as a component of a proper, comprehensive care (42). ...
Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.
... Moreover, nutritional status was assessed throughout the duration of cancer treatments in 55.6% of cases. Cancer-related malnutrition is very common among patients affected by solid malignancies, with a high percentage of patients experiencing malnutrition during the course of their disease due to several reasons, including the type of tumor, the disease stage and the type of treatment (e.g., surgery, chemotherapy, concomitant RT-CT, etc.) (39)(40)(41). Thus, it is mandatory to identify cancer patients at nutritional risk as a component of a proper, comprehensive care (42). ...
... Thus, in terms of investing in research, clinicians and laboratory groups selected immunonutrition therapy in trauma and surgical patients, especially during the perioperative period [47][48][49][50]. Encouraging findings about the benefits of immunonutrition have been collected by cancer-related surgery [51], while studies on orthopedic and traumatic patients have been limited to date. ...
The role of nutrition intervention in surgical settings is constantly developing and evolving. Immunonutrition represents a viable option to reduce perioperative and postoperative complications in surgical oncology. However, as far as we know, little research has been conducted in the orthopedic field. With this review, we aim to summarize the state of the art in the application of immune-enhanced compounds to surgical, orthopedic, and traumatic patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adopted. A comprehensive search was carried out using the PubMed (MEDLINE), EMBASE, and Cochrane Library databases. All the studies dealing with immunonutrition fed to traumatic and orthopedic patients were pooled, the data were extracted, and the studies were discussed. A total of eight studies were included: six focused on trauma surgery and two on elective orthopedic surgery. The epidemiological characteristics of participants and the assessment of results were reported. Data were analyzed using R software (2020; R Core Team). Based on the current available literature, a positive impact of immunonutrition in orthopedic and trauma surgical settings was registered. All studies analyzed showed the favorable impact of the immunonutrition diet on clinical outcomes. The full effect of this type of nutrition and its different applications in the orthopedic and traumatic fields should be critically investigated through more extensive randomized controlled trials.
... The findings are in support of other similar studies. 14,15 In this study, it is found that patients treated with immunonutrients in the postoperative period have significantly fewer (p-value <0.05) wound infections (12%) as compared to those treated conventionally (35%). Various other studies reported similar observations. ...
... Some studies showed that oral intake of amino acids, like arginine, glutamine, vitamins, omega-3 fatty acids, and nucleotides positively impact the immune system and decrease postoperative complications [14,16]. But there is no approved recommendation for liver transplantation, liver and pancreas resection [6,7]. ...
In perioperative care after liver resection, transplantation and pancreatoduodenectomy, ERAS (Enhanced Recovery After Surgery) recommendations are based on the reducing invasiveness of procedures and the severity of the surgical stress, which results in decreasing complications and enhanced recovery. Recommendations for all three operations can be classified into five groups: recommended for all patients, recommended for special patient groups, rejected for all patients, controversial recommendations, specific recommendations for all three operations.
Preoperative counselling and psychological support, nutritional support, smoking and alcohol cessation, pre- and intraoperative antibiotic prophylaxis, thrombosis prevention, limiting of preoperative hunger and thirst to 4 and 6 hours, preoperative intaking carbohydrate rich drink, alcohol-based antiseptics for skin preparation, a goal-directed infusion therapy, providing normothermia, early removal of the drainage tube, glycemic control, dual antiemetic therapy, multimodal analgesia strategies, early oral feeding and activation, audit recommend for all patients. Postoperative antibiotic prophylaxis, enteral and parenteral nutrition, short-acting anxiolytics are recommended for individual patients. It is recommended to avoid Mercedes type incision, use of long-acting anxiolytics and postoperative nasogastric tube. The benefits of preoperative physical exercise, immunonutrition and probiotics are controversial. There are no specific recommendations for thoracic epidural anesthesia, preventing delayed gastric emptying and intestinal paresis in liver surgery.
... Enteral immunonutrition (EIN) with specific nutrients such as arginine, glutamine, omega-3 fatty acids, and nucleotides is typically supplemented in formulations (19). EIN can improve nutrition status and enhance immune function (20)(21)(22)(23)(24). Some published clinical studies suggested that perioperative EIN administration, enriched with at least two of the immunonutrition nutrients, is beneficial for reducing complications after major abdominal surgery, particularly in malnourished patients (23)(24)(25)(26)(27). ...
... EIN can improve nutrition status and enhance immune function (20)(21)(22)(23)(24). Some published clinical studies suggested that perioperative EIN administration, enriched with at least two of the immunonutrition nutrients, is beneficial for reducing complications after major abdominal surgery, particularly in malnourished patients (23)(24)(25)(26)(27). However, not all studies could draw a similar conclusion; some suggested that EIN does not significantly reduce postoperative complications, mortality, and length of hospital stay (28)(29)(30). ...
... By examining the full texts, 198 articles were excluded for non-RCT, no data available, no EIN, no surgical treatment, and duplicate, leaving 35 eligible articles for the final quantitative analysis (23, 24, 26-28, 30, 34-55). (25,28,38,44,48,53,56,58,59), six from Poland (26,30,(39)(40)(41)52), four from Italy (24,34,37,49), four from China (23,43,46,54), three from Spain (45,50,51), two from England (22,36), two from Switzerland (35,42), two from Turkey (27,55), one from Denmark (57), one from Korea (47), and one from Australia (29). A total of 3,692 patients undergoing surgery for gastrointestinal cancer were included in the 35 studies. ...
Background
The efficacy of enteral immunonutrition (EIN) in patients undergoing gastrointestinal cancer surgery remains debatable. This meta-analysis aimed to investigate the effectiveness of EIN administration in patients undergoing surgery for gastrointestinal cancer.
Methods
From January 2000 to January 2022, PubMed, EMBASE, Cochrane Library, and Web of Science were thoroughly searched for randomized controlled trials (RCTs) with EIN versus standard diet or no supplement in patients undergoing surgery for gastrointestinal cancer. Overall complications and infectious complications were the primary outcomes. The secondary results were non-infectious complications, mortality, length of hospital stay, and enteral nutrition-related complications.
Results
Thirty-five studies reporting 3,692 patients undergoing surgery for gastrointestinal cancer (including gastric cancer, colorectal cancer, esophageal cancer, periampullary cancer, or pancreatic cancer) were included. Compared with the control group, EIN group had a significantly decreased incidence of overall complications (RR = 0.79, p < 0.001). Infectious complications in patients who received EIN were considerably lower than in the control group (RR = 0.66, p < 0.001). Compared to the control group, the incidence of surgical site infection, abdominal abscess, anastomotic leakage, bacteremia, duration of systemic inflammatory response syndrome (SIRS), and duration of antibiotic therapy was significantly lower in the specific infectious complications treated with EIN. Still, there was no significant difference between the two groups with other infectious complications. Moreover, a substantial shortening in the length of hospital stay was shown in EIN group compared with the control group. Still, no significant effect of EIN was demonstrated in non-infectious complicatios and mortality. The enteral nutrition-related complications had no significant difference between two groups.
Conclusions
EIN is safe and effective in reducing overall complications, infectious complications, and hospital stay in patients undergoing gastrointestinal cancer surgery (including gastric cancer, colorectal cancer, esophageal cancer, periampullary cancer, or pancreatic cancer).
