IMMUNO-ERAS: PREOPERATIVE IMMUNONUTRITION IN PATIENTS UNDERGOING ELECTIVE LIVER SURGERY WITHIN ERAS PATHWAY

Abstract

To assess the impact of preoperative immunonutrition versus a standard oral nutritional supplement (ONS) in patients undergoing elective liver surgery within an ERAS pathway. One hundred patients undergoing liver resection within an ERAS pathway were randomized either 7 day of preoperative ONS enriched with immunonutrients (3 briks/day, IM group) or isocaloric-isonitrogenous ONS (3 briks/day, control group). The primary outcome was the length of postoperative hospital stay. Secondary outcomes were the 30-day postoperative complications and readmission, compliance with treatment, and changes of nutritional and functional parameters (body weight, BMI and hand-grip strength). An intention-to-treat analysis was performed. The two groups were homogeneous both in terms of preoperative and surgical characteristics and in terms of adherence to the ERAS protocol, high in both groups. Most patients had a low nutritional risk before surgery in both groups [MUST score=0: 80%vs78%; p=0,793]. The median length of the postoperative hospital stay was 5 days with no differences between the groups. The 30-day postoperative total complications, infection complications and readmission were similar in both groups (Table 1). In the IM group there was a greater compliance with nutritional treatment, but not statistically significant. The nutritional and functional parameters remained stable during perioperative period with no significant differences between the groups. In the context of ERAS pathway, preoperative immunonutrition does not appear to further improve postoperative outcomes in patients at low nutritional risk undergoing liver surgery compared to a standard ONS. Future studies could be useful to evaluate possible benefit in malnourished patients.