The benefit of immunonutrition in patients undergoing hepatectomy: a systematic review and meta-analysis.

Feng Li,Ning Sun,Chengshuo Zhang,Ao Jiao,Jialin Zhang,Bowen Wang,Baomin Chen

doi:10.18632/oncotarget.20045

Feng Li, Ning Sun + Show 5 more

Open Access

https://doi.org/10.18632/oncotarget.20045

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Journal: Oncotarget	Publication Date: Aug 8, 2017
Citations: 14	License type: cc-by

Affiliation: First Hospital of China Medical University

Abstract

Perioperative immunonutrition in liver resection remains doubtful. A systematic review and meta-analysis was conducted to compare postoperative outcomes between patients undergoing hepatectomy who received perioperative immunonutrition and those who did not.A PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Knowledge database search was performed to retrieve all of the randomized controlled trials (RCTs) evaluating the value of perioperative immunonutrition in patients undergoing hepatectomy until the end of September 2016. Data extraction and quality assessment of RCTs were performed in accordance with PRISMA guidelines. The quality of evidence for each postoperative outcome was assessed using the GRADEpro analysis. A random-effects model was used to conduct a meta-analysis with RevMan 5.3.5 software. Eight RCTs including 805 patients (402 with and 403 without immunonutrition) were identified. Immunonutrition, mainly ω-3 fatty acids, significantly reduced the incidence of postoperative total complications (risk ratio [RR] = 0.59; 95% confidence interval [CI], 0.46–0.75; p < 0.0001) and infectious complications (RR = 0.46; 95% CI, 0.32–0.68; p < 0.0001), and shortened the length of hospital stay (standardized mean difference, −0.49; 95% CI, −0.81 to −0.16; p = 0.0004). There was no significant between-group difference in postoperative mortality (RR = 0.46; 95% CI, 0.16–1.31; p = 0.15). Immunonutrition, mainly ω-3 fatty acids, is potentially beneficial in reducing overall and infectious postoperative complications and in shortening the hospital stay for patients undergoing hepatectomy.

Highlights

Hepatectomy is the principal treatment for eligible patients with benign and malignant hepatobiliary diseases
Immunonutrition, mainly ω-3 fatty acids, significantly reduced the incidence of postoperative total complications and infectious complications (RR = 0.46; 95% confidence interval (CI), 0.32–0.68; p < 0.0001), and shortened the length of hospital stay
Pooled analysis showed that immunonutrition significantly reduced the incidence of postoperative total complications (risk rate (RR) = 0.59; 95% confidence interval (CI), 0.46–0.75; p < 0.0001)

Summary

Introduction

Hepatectomy is the principal treatment for eligible patients with benign and malignant hepatobiliary diseases. Improvements in operative techniques and perioperative management have markedly ameliorated the prognosis of patients undergoing hepatectomy [1], the rate of postoperative complications remains high, as shown by longer hospital stay and increased mortality [2]. Patients are administered immunonutrition to increase their nitrogen balance and protein synthesis, modulate postsurgical immunosuppression and inflammatory responses, and improve the host immune state [4, 5]. Immunonutrition support in patients undergoing major elective upper gastrointestinal (GI) surgery has been found to improve their immunologic, metabolic, and clinical outcomes [6]. The guidelines of the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) have recommended www.impactjournals.com/oncotarget immunonutrition in patients undergoing abdominal operations, especially those with upper GI cancer [8, 9]

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