Abstract
Immunonutrition (IN) appears to reduce infective complications and in-hospital length of stay (LOS) after major gastrointestinal surgery, but its use in normo-nourished patients is still controversial. The primary aim of this comparative observational study was to evaluate if pre-operative IN reduces in-hospital stay in patients undergoing laparoscopic colorectal resection for cancer under an enhanced recovery after surgery (ERAS) program. The influence of IN on time to first bowel movements, time to full oral diet tolerance, number and type of complications, reasons of prolonged LOS and readmission rate was evaluated as secondary outcome. Patients undergoing ERAS laparoscopic colorectal resection between December 2016 and December 2019 were reviewed. Patients who have received preoperative IN (group A) were compared to those receiving standard dietary advice (group B). Mean in-hospital LOS was significantly shorter in patients receiving preoperative IN than standard dietary advice (4.85 ± 2.25 days vs. 6.06 ± 3.95 days; p < 0.0492). No differences in secondary outcomes were observed. Preoperative IN associated with ERAS protocol in normo-nourished patients undergoing laparoscopic colorectal cancer resection seems to reduce LOS.
Highlights
Immunonutrition (IN) has been introduced in clinical practice to improve nutritional status and positively influence host immune response to surgical stress [1,2,3]
Fifty-seven patients (24.8%) did not meet the inclusion criteria and were excluded from the analysis: thirty-two (13.9%) were found malnourished, three patients had emergency surgery, one was classified at high risk for surgery (ASA IV), twelve laparoscopic operations were eventually converted to open surgery and nine patients had multivisceral resections
Fifty-seven patients (24.8%) did not meet the of 11 found m clusion criteria and were excluded from the analysis: thirty-two (13.9%)5were nourished, three patients had emergency surgery, one was classified at high risk for s gery (ASA IV), twelve laparoscopic operations were eventually converted to open surg and nine patients had multivisceral resections
Summary
Immunonutrition (IN) has been introduced in clinical practice to improve nutritional status and positively influence host immune response to surgical stress [1,2,3]. IN requires the use of special immune-modulating nutrients in higher doses than standard nutritional protocols. In most ERAS protocols, a large amount of space is dedicated to perioperative nutrition, carbohydrates load and restriction in parenteral fluids administration [6,7]. Few studies focus on patients with colorectal cancer undergoing elective surgery [6]. Preoperative IN in normo-nourished patients undergoing enhanced-recovery after surgery (ERAS) laparoscopic colorectal surgery needs a better evaluation due to controversial or low-quality evidence [8,9,10]. The primary outcome of this study was to evaluate a protocol of preoperative IN and perioperative maltodextrins load in patients undergoing ERAS laparoscopic colorectal resection for cancer
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