The Role of Total Parenteral Nutrition in Patients with Peritoneal Carcinomatosis: A Systematic Review and Meta-Analysis.

Xing-Yi Sarah Ong,Rehena Sultana,Jolene Si Min Wong,Chin-Ann Johnny Ong,Qiu Xuan Tan,Joey Wee-Shan Tan,Claramae Shulyn Chia

doi:10.3390/cancers13164156

Abstract

Simple SummaryPatients with peritoneal carcinomatosis often develop complications which prevent them from receiving adequate oral intake. This can contribute to malnutrition, as well as increased morbidity and mortality. In such patients, total parenteral nutrition, which involves the intravenous administration of nutrients thereby bypassing the oral route, can be lifesaving. In this study, we performed a systematic review and meta-analysis of the existing literature to evaluate the effect of total parenteral nutrition on the survival of patients with peritoneal carcinomatosis. In light of the limited treatment options available, total parenteral nutrition may improve survival outcomes, but further studies are needed to conclude definitively.Peritoneal carcinomatosis (PC) is often associated with malnutrition and an inability to tolerate enteral feeding. Although total parenteral nutrition (TPN) can be lifesaving for patients with no other means of nutritional support, its use in the management of PC patients remains controversial. Therefore, a systematic review and meta-analysis was performed to evaluate the benefit of TPN on the overall survival of PC patients, in accordance with PRISMA guidelines. A total of 187 articles were screened; 10 were included in this review and eight were included in the meta-analysis. The pooled median overall survival of patients who received TPN was significantly higher than patients who did not receive TPN (p = 0.040). When only high-quality studies were included, a significant survival advantage was observed in PC patients receiving TPN (p < 0.001). Subgroup analysis of patients receiving chemotherapy demonstrated a significant survival benefit (p = 0.008) associated with the use of TPN. In conclusion, TPN may improve survival outcomes in PC patients. However, further studies are needed to conclude more definitively on the effect of TPN.

Highlights

Peritoneal carcinomatosis (PC) refers to the metastatic involvement of the peritoneum, typically secondary to gastrointestinal, gynecological, or other rare malignancies
Relevant primary studies were systematically searched for using keywords and database-specific index terms for “total parenteral nutrition”, “peritoneal carcinomatosis”, “peritoneal metastases”, and “peritoneal disease” in PubMed, MEDLINE (Ovid), Embase, CINAHL, Web of Science, and Scopus, with filters applied for human subjects and English-language papers
The benefit of total parenteral nutrition (TPN) remains closely determined by the tumor biology and baseline health status of PC patients

Summary

Introduction

Peritoneal carcinomatosis (PC) refers to the metastatic involvement of the peritoneum, typically secondary to gastrointestinal, gynecological, or other rare malignancies. It is often associated with poor prognosis, disease progression [1], and high rates of malnutrition [2], which are in turn associated with increased morbidity and mortality [3]. Palliative attempts to debulk tumor burden are challenging [5] and rarely confer an increase in overall survival [7], especially in nongynecological cancers; key factors deterring resection include tumor burden, response to chemotherapy, and length of the disease-free interval. With regard to gynecological cancers, the results of recent studies suggest that secondary cytoreductive surgery (CRS). Malnutrition affects patients’ eligibility and tolerance for CRS-HIPEC [13], as its effect on the immune function often leads to an increase in postoperative infection rates, complications in wound healing, and length of hospital stays [14]

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