The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy.

Beata Jabłońska,Sławomir Mrowiec

doi:10.3390/nu12092547

Beata Jabłońska, Sławomir Mrowiec

Open Access

https://doi.org/10.3390/nu12092547

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Journal: Nutrients	Publication Date: Aug 23, 2020
Citations: 18	License type: CC BY 4.0

Affiliation: Medical University of Silesia

Abstract

Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgical procedures in abdominal surgery. Malnutrition and immune dysfunction in patients with pancreatic cancer (PC) may lead to a higher risk of postoperative infectious complications. Although immunonutrition (IN) is recommended for enhanced recovery after surgery (ERAS) in patients undergoing PD for 5–7 days perioperatively, its role in patients undergoing pancreatectomy is still unclear and controversial. It is known that the proper surgical technique is very important in order to reduce a risk of postoperative complications, such as a pancreatic fistula, and to improve disease-free survival in patients following PD. However, it has been proven that IN decreases the risk of infectious complications, and shortens hospital stays in patients undergoing PD. This is a result of the impact on altered inflammatory responses in patients with cancer. Both enteral and parenteral, as well as preoperative and postoperative IN, using various nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides, is administered. The most frequently used preoperative oral supplementation is recommended. The aim of this paper is to present the indications and benefits of IN in patients undergoing PD.

Highlights

Pancreaticoduodenectomy (PD) is one of the most complex surgical procedures in gastrointestinal surgery
This study has shown that patients with low skeletal muscle mass index (SMI) are candidates for IN before PD
This analysis showed that IN significantly reduced the incidence of postoperative infectious complications (RR 0.58, 95% confidence interval (CI) 0.37–0.92; p = 0.02) and shortened the length of hospital stay (MD −1.79, 95% CI −3.40 to 0.18; p = 0.03)

Summary

Introduction

Pancreaticoduodenectomy (PD) is one of the most complex surgical procedures in gastrointestinal surgery. Most frequently, it is indicated for patients with malignant tumors of the pancreatic head, the distal common bile duct, and periampullary tumors. Some benign pancreatic and periammpullary diseases, such as inflammatory tumors within pancreatic head in the course of chronic pancreatitis or other benign diseases, are indications for PD. Regardless of surgery indications, PD is associated with a risk of postoperative complications. The morbidity rate after PD has (30–40%). The perioperative mortality rate still ranges 0–5% [1]. Postoperative pancreatic fistula (POPF) remains the most common complication after PD, and this complication significantly prolongs the duration of hospitalization and leads to high medical costs [1]

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