Abstract

SummaryBackground & aimsImmune modulating nutrition (IMN) has been shown to reduce postoperative infectious complications and length of stay in patients with gastrointestinal cancer. Two studies of IMN in patients undergoing surgery for head and neck cancer also suggested that this treatment might improve long-term survival and progression-free survival. In the present study, we analysed follow-up data from our previous randomised controlled trial of IMN, in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer, in order to evaluate the long-term impact on survival of postoperative IMN versus an isocaloric, isonitrogenous control feed.MethodsThis study included patients undergoing surgery for cancers of the pancreas, oesophagus and stomach, who had been randomised in a double-blind manner to receive postoperative jejunostomy feeding with IMN (Stresson, Nutricia Ltd.) or an isonitrogenous, isocaloric feed (Nutrison High Protein, Nutricia) for 10–15 days. The primary outcome was long-term overall survival.ResultsThere was complete follow-up for all 108 patients, with 54 patients randomised to each group. There were no statistically significant differences between groups by demographics [(age, p = 0.63), sex (p = 0.49) or site of cancer (p = 0.25)]. 30-day mortality was 11.1% in both groups. Mortality in the intervention group was 13%, 31.5%, 70.4%, 85.2%, 88.9%, and 96.3% at 90 days, and 1, 5, 10, 15 and 20 years respectively. Corresponding mortality in the control group was 14.8%, 35.2%, 68.6%, 79.6%, 85.2% and 98.1% (p > 0.05 for all comparisons).ConclusionEarly postoperative feeding with arginine-enriched IMN had no impact on long-term survival in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer.

Highlights

  • The 5-year survival rate for oesophagogastric and pancreaticobiliary cancers is amongst the worst of all tumour types [1]

  • The aim of this study was to analyse long-term survival from our previous randomised control trials (RCT) [5] to determine if arginine supplementation, as part of postoperative enteral immune modulating nutrition (IMN), in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer, improved longterm survival when compared with an isocaloric isonitrogenous control feed

  • This study found that early postoperative enteral feeding with arginine-enriched IMN conferred no additional benefit on either the short or long-term mortality when compared with an isocaloric, isonitrogeneous control formula in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer

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Summary

Introduction

The 5-year survival rate for oesophagogastric and pancreaticobiliary cancers is amongst the worst of all tumour types [1]. Our own RCT from 2006 found no difference in 30-day mortality rate between patients receiving postoperative IMN and those given a standard isocaloric, isonitrogenous enteral feed [5]. Two studies in patients undergoing surgery for head and neck cancers appear to show improved long-term survival in patients randomised to an arginine-containing feed arm when compared with controls [6,7]. We analysed follow-up data from our previous randomised controlled trial of IMN, in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer, in order to evaluate the long-term impact on survival of postoperative IMN versus an isocaloric, isonitrogenous control feed. Conclusion: Early postoperative feeding with arginine-enriched IMN had no impact on long-term survival in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer.

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