Perioperative Enteral Immunonutrition Research Articles

ASO Visual Abstract: The Impact of Perioperative Enteral Immunonutrition on Postoperative Complications in Astrointestinal Cancer Surgery: A Meta-Analysis.

ASO Visual Abstract: The Impact of Perioperative Enteral Immunonutrition on Postoperative Complications in Astrointestinal Cancer Surgery: A Meta-Analysis.

The Impact of Peri-operative Enteral Immunonutrition on Post-operative Complications in Gastrointestinal Cancer Surgery: A Meta-Analysis.

Immunonutrition (IMN) in gastrointestinal (GI) cancer surgery remains under-utilised and contentious. Despite previous meta-analysis reporting benefit, most recent randomised control trials (RCTs) have failed to demonstrate this and have recommended against its routine use. A contemporary meta-analysis may contribute to the recommendations for immunonutrition use and help select which patients may benefit. The objective of this study was to review IMN and its impact on post-operative outcomes in GI cancer surgery, exploring its role in both malnourished and non-malnourished populations, the optimal dose to use, cancer type of patients using IMN and the timing of IMN relative to the peri-operative period. The EMBASE and Medline databases were searched from 2000 to 2022 for RCTs evaluating IMN in adults undergoing GI cancer surgery. Thirty-seven studies were included (22 pre-operative IMN studies, 11 peri-operative IMN trials and 9 post-operative IMN trials; 4 trials had multiple IMN protocols) that reported on 3793 patients. The main outcome of post-operative infectious complications was reduced with IMN [odds ratio (OR) 0.58, 95% confidence interval (CI) 0.47-0.72]. This association was significant in subgroup analysis only with pre-operative and peri-operative administration and in trials including upper GI cancers, colorectal cancer and 'mixed GI' cancer populations, and significance was independent of nutritional status. IMN in pooled analysis reduced surgical site infection (SSI) (OR 0.65, 95% CI 0.52-0.81), anastomotic leak (OR 0.67, 95% CI 0.47-0.93) and length of stay (LOS) by 1.94 days (95% CI -3 to -0.87). Immunonutrition was associated with reduced post-operative complications. Peri-operative administration may be the preferred strategy in reducing infectious complications, anastomotic leak, SSI and LOS.

The impact of immunomodulatory enteral nutrition on patients submitted to elective gastrointestinal cancer surgery: integrative review

Objective:  To carry out a review about the use of enteral nutrition composed of immunonutrients in cancer patients undergoing elective surgery in the gastrointestinal tract on surgical outcomes. Methods: The research was carried out in the Medline, Lilacs and Pubmed databases. Results: The administration of enteral diet in both groups was well tolerated, there was no significant difference in the mortality rate and in the Intensive Care Unit or postoperative hospital stay. The immunomodulatory nutritional therapy was favorable to decrease the TNFα values and increase the total lymphocyte count in the postoperative period. Perioperative enteral immunonutrition has no significant effects on mortality rate, length of hospital stay and complications in gastrointestinal tract surgeries.  Final considerations: Immunonutrition appears to be promising in terms of modulating the immune response. More randomized studies are needed regarding the effects of immunonutrients on abdominal surgical cancer patients.

Perioperative enteral immunonutrition with probiotics favors the nutritional, inflammatory, and functional statuses in digestive system surgery.

This study aimed to evaluate the effects of enteral immunonutrition (EIN) on the nutritional status of patients during the perioperative period of digestive system surgery. The clinical data of 102 patients who underwent gastrointestinal surgery between August 2017 and February 2021 were retrospectively analyzed. According to the nutritional support regimen, the patients were divided into an enteral nutrition (EN) group (50 patients) and an EIN group (52 patients). The times (in hours) to return of the first bowel sound, first postoperative flatus, and first bowel movement, as well as the length of postoperative hospital stay were shorter in the EIN group than in the EN group (p<0.05). The concentrations of hemoglobin, prealbumin, albumin, and transferrin, as well as the concentrations of immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), complement C3, and complement C4 were higher in the EIN group than in the EN group at 1 and 7 days after surgery (p<0.05). The concentrations of endotoxins, D-lactic acid, and diamine oxidase were lower in the EIN group than in the EN group (p<0.05). The tolerance to enteral feeding was better in the EIN group than in the EN group (p<0.05). The incidence of complications was lower in the EIN group (5.77%) than in the EN group (10.0%) (p>0.05). EIN can promote gastrointestinal function recovery, improve the nutritional status, enhance the humoral immune function, regulate intestinal flora balance, improve intestinal permeability, prevent enteral feeding intolerance, and reduce complications in patients undergoing surgery for digestive system diseases.

Impact of perioperative enteral immunonutrition in patients with gastrointestinal cancer undergoing elective surgery: a randomized controlled trial

Rationale: Major cancer surgery poses a significant risk to patient’s nutritional intake, especially among gastrointestinal cancer patients. Patients are often at high risk of a remarkable weight loss and impaired functional capacity after surgery. The aim of our study is to investigate the effects of two immune-modulating formulas on nutritional status and functional capacities in patients undergoing elective surgery.

Enteral immunonutrition versus enteral nutrition for patients undergoing esophagectomy: a randomized controlled trial.

In recent years, immunonutrition has been introduced and proposed to have a positive modulatory effect on inflammatory and immune responses and gut function for surgical patients, especially for patients undergoing gastrointestinal cancer resection. We conducted this parallel-group, randomized and double-blind clinical controlled trial to investigate the efficacy of perioperative enteral immunonutrition (EIN) on clinical and immunological outcomes of patients undergoing esophageal resection. A randomized, parallel-group, double-blind, clinical trial was conducted between December 1, 2017 and March 1, 2018. This study enrolled 120 patients with esophageal cancer. And 112 patients were divided into two groups randomly: EIN group and enteral nutrition (EN) group. The EIN contained extra immunonutritional substrates, including a consistent combination of arginine, RNA and the omega-3 fatty acids compared with EN. Immune indicators were measured at preoperative day 7, postoperative day (POD) 1, 3, 7 and post-discharge day (PDD) 30. There were 56 participants randomized to each group. Finally, 53 patients in EIN and 50 patients in EN were analyzed. Immune indicator was the primary outcome in this study. EIN yielded a significantly lower rate of CD8/CD3 (%) at POD 3 compared with EN group (P=0.005). The rate of CD4/CD8 (%) in EIN group was higher than that in EN group at POD3 (P=0.004). The serum levels of IgM at POD 3 and 7 were significantly higher in EN group compared with EIN group (P=0.025 and P=0.009, respectively). The rate of NK (%) and the serum level of IgA were significantly higher in EIN group compared with EN group at PDD 30 (P=0.022 and P=0.041, respectively). No significant differences were found in 2-year progressionfree survival and overall survival. Immunonutrition is a safe and feasible nutritional treatment, which has a positive modulatory impact on immune responses after esophagectomy. Although no significant difference was found in clinical and survival outcomes between EIN and EN groups, immunonutrition could still have a positive effect on immunological function of patients undergoing esophagectomy.

Perioperative immunonutrition in esophageal cancer patients undergoing esophagectomy: the first meta-analysis of randomized clinical trials.

Although several randomized controlled trials have been published in recent years, the effect of perioperative immunonutrition in esophageal cancer (EC) patients remains unclear. This initial meta-analysis was conducted to assess whether perioperative enteral immunonutrition reduces postoperative complications in patients undergoing esophagectomy for EC. Relevant randomized controlled trials published before 1st September 2019 were retrieved from the Cochrane Library, PubMed, and EMBASE databases. After the literature was screened, two researchers extracted the information and data from eligible studies according to predefined selection criteria. Obtained data were pooled and analyzed by RevMan 5.3 software. The results were presented as risk ratios (RRs) with 95% confidence intervals (CIs). The heterogeneity among studies was tested by I2 test. Seven high-quality randomized controlled trials were included, with a total of 606 patients, 311 of whom received immunonutrition before and after surgery, while 295 received perioperative standard nutrition. No significant difference was observed between the two groups in the incidence of postoperative infection complications, including total infection complications (RR = 0.97, CI: 0.78-1.20, P =0.76), pneumonia (RR = 0.97, CI: 0.71-1.33, P =0.84), wound infection (RR = 0.80, CI: 0.46-1.40, P =0.44), sepsis (RR = 1.35, CI: 0.67-2.71, P =0.40), and urinary tract infection (RR = 0.87, CI: 0.54-1.40, P =0.56). The prevalence of anastomotic leakage in the two groups was 9.4 and 5.4%, but the difference was not statistically significant (RR = 0.59, CI: 0.33-1.04, P =0.07). Perioperative enteral immunonutrition provided no benefit in terms of the incidence of infection complications and anastomotic leakage in EC patients undergoing esophagectomy. Further large-scale randomized controlled trials are needed to confirm this conclusion.

The impact of perioperative enteral immunonutrition on frequent clinical outcome in patients with digestive system cancer

Background: Forepassed trials have indicated that perioperative enteral immunonutrition can improve the clinical outcome for patients with digestive system cancer. The purpose of this study was to evaluate the effect of perioperative enteral immunonutrition on immunity and postoperative complications in patients with digestive system cancer. Methods: A group of 64 patients with digestive system cancer was randomly assigned for perioperative enteral immunonutrition (n=32) or standard enteral nutrition (n=32). The postoperative clinical outcome was assessed based on a clinical index, including postoperative complications, and systemic inflammatory response syndrome (SIRS) duration. Also, the postoperative cellular immunity was compared and evaluated between the two groups. Results: The nutritional therapy of both groups were completed. The occurrence of postoperative infectious complications in the immunonutrition group (6%) was significantly (P=0.020) lower than that of the standard nutrition group (28%). The duration of SIRS in the immunonutrition group (0.77±0.91 days) was significantly shorter than that in the standard nutrition group (1.34±1.46 days) (P=0.012). The postoperative lymphocyte counts and CD4+ T-cells counts significantly declined (P Conclusions: In comparison to standard enteral nutrition, perioperative enteral immunonutrition with glutamine (Gln), ω-3 fatty acids, nucleotide and arginine (Arg) improved the immune status of the patients, reduced the occurrence of postoperative infectious complications and decreased the duration of SIRS. CD4+ T-cells immunity possibly played a vital role in the inflammatory response and the modulation of postoperative immunity after surgery with digestive system cancer.

Meta-analysis of perioperative enteral immunonutrition and morbidity in radical cystectomy

Meta-analysis of perioperative enteral immunonutrition and morbidity in radical cystectomy

Effects of perioperative enteral EPA-enriched immunonutrition on meaningful loss of lean body mass after total gastrectomy for gastric cancer: Post hoc analysis of a phase III study.

85 Background: Total gastrectomy for gastric cancer significantly reduces body weight, especially lean body mass (LBM), through surgical stress and decrease of the calorie intake. Eicosapentaenoic acid (EPA)-enriched enteral nutrition (EPA-EN) could modulate immune function and limits catabolism. In our phase III study to compare perioperative standard diet with or without EPA-EN, additional EPA-EN did not contribute to prevent weight loss or LBM. Recently, 5% or more LBM loss after surgery was reported to impair compliance of post-operative S-1 adjuvant chemotherapy. This post hoc study explored whether additional EPA-EN prevented meaningful loss of LBM for compliance of adjuvant chemotherapy after surgery. Methods: Key entry criteria of this phase III study was (1) histologically proven adenocarcinoma of the stomach, (2) clinical T1-T4a and M0, (3) R0 resection is possible by total gastrectomy, (4) sufficient oral intake, and (5) sufficient organ function. The patients were randomized to Group A: no supplementation with oral nutrients (standard diet) or Group B: standard diet with oral supplementation of ProSure including 600 kcal with 2.2 g EPA for 7 days before surgery and for 21 days after surgery. For both groups, patients underwent total gastrectomy with Roux-en Y reconstruction. Results: A total of 127 patients (Group A: 63, Group B: 64) were enrolled in the study. All background factors were well balanced between the both groups. Median relative performance of supplement in group B was 100% before surgery and 54% after surgery. 5% or more LBM loss at 1 month after surgery was observed in 44 patients (80.0%) in group A and in 37 patients (67.3%) in group B (p = 0.194), while that at 3 months after surgery was found in 51 patients (91.1%) in group A and in 43 patients (76.8%) in group B (p = 0.070). Conclusions: Perioperative standard diet with EPA-enriched enteral nutrition tended to prevent meaningful loss of LBM after total gastrectomy. Further analysis is required whether perioperative EPA enriched EN improve compliance of S-1 adjuvant chemotherapy after total gastrectomy. Clinical trial information: UMIN000006380.

1122 A phase III trial to confirm preventing effects of perioperative enteral EPA-enriched immunonutrition on body weight loss after total gastrectomy for gastric cancer

1122 A phase III trial to confirm preventing effects of perioperative enteral EPA-enriched immunonutrition on body weight loss after total gastrectomy for gastric cancer

Preoperative enteral immunonutrition in cancer patients undergoing major abdominal surgery: Results of a meta-analysis.

e14005 Background: Perioperative enteral immunonutrition is thought to reduce the acute phase response and postoperative morbidity in patients undergoing major abdominal surgery. This meta analysis...

Impact of Perioperative Enteral Immunonutrition on Infectious Complications After Major Gastrointestinal Surgery

Objective: To study the impact of perioperative, enterally administered whey protein concentrate on infectious complications after major elective gastrointestinal surgery in a tertiary care hospital. Materials and Methods: Prospective non-randomized study conducted from June 2008–April 2010, which included 50 consecutive patients who underwent major elective gastrointestinal surgery for benign and malignant diseases. The primary outcome measured was the rate of infectious complications, and the secondary outcome was length of postoperative stay. Results: 50 patients were divided into two equal groups: Group 1 and Group 2 (n=25 each). One group received immune-enhanced enteral nutrition (IMEN) perioperatively, and the control group received standard enteral nutrition (SEN) during the same period. There were no significant differences between the two groups with regard to complications (P=0.26), either infective (P=0.76) or non-infective (P=0.65). There was no significant difference in the duration of postoperative stay (P=0.25) between the two groups. There was also no significant difference in the pre- and postoperative White Blood Cell (WBC) count, C-Reactive Protein (CRP), and albumin levels. However, a subgroup analysis carried out to identify malnourished patients in the immunonutrition group revealed significant reduction in the length of postoperative stay (P=0.03) but not the rate of infectious complications (P=0.20). Conclusion: Perioperatively administered immunonutrition did not decrease the incidence of postoperative infectious complications and the duration of postoperative stay. Malnourished patients given immunonutrition in the perioperative period showed a significant reduction in the length of postoperative hospital stay but not the incidence of infective complications.

Immunonutrition in gastrointestinal surgery

Patients undergoing major gastrointestinal surgery are at increased risk of developing complications. The use of immunonutrition (IN) in such patients is not widespread because the available data are heterogeneous, and some show contradictory results with regard to complications, mortality and length of hospital stay. Randomized controlled trials (RCTs) published between January 1985 and September 2009 that assessed the clinical impact of perioperative enteral IN in major gastrointestinal elective surgery were included in a meta-analysis. Twenty-one RCTs enrolling a total of 2730 patients were included in the meta-analysis. Twelve were considered as high-quality studies. The included studies showed significant heterogeneity with respect to patients, control groups, timing and duration of IN, which limited group analysis. IN significantly reduced overall complications when used before surgery (odds ratio (OR) 0·48, 95 per cent confidence interval (c.i.) 0·34 to 0·69), both before and after operation (OR 0·39, 0·28 to 0·54) or after surgery (OR 0·46, 0·25 to 0·84). For these three timings of IN administration, ORs of postoperative infection were 0·36 (0·24 to 0·56), 0·41 (0·28 to 0·58) and 0·53 (0·40 to 0·71) respectively. Use of IN led to a shorter hospital stay: mean difference -2·12 (95 per cent c.i. -2·97 to -1·26) days. Beneficial effects of IN were confirmed when low-quality trials were excluded. Perioperative IN had no influence on mortality (OR 0·90, 0·46 to 1·76). Perioperative enteral IN decreases morbidity and hospital stay but not mortality after major gastrointestinal surgery; its routine use can be recommended.

Clinical study and nursing observation of effect of perioperative enteral immunonutrition on the host immune function in pancreatoduodenectomy patients

Objective To evaluate the effect of perioperative enteral immunonutrition on the host immune function in panereatoduodeneetomy patients,and nursing experience for enteral nutrition.Methods Forty pancreatoduodenectomy cases were divided into enteral immunonutrition(EIN)group and regular enteral nutrition (EN)group with 20 cases respectively.The complieations related to enteral nutrition were earefttlly observed.Host immunity function were measured by CD3,CD4,CD8,CD4/CDS,NK,IgG,IgM,IgA on pre-nutrition,pre-operative 1 day,postoperative 1,7,14,21 and 28 day.Results Forty cases all completed the study and smoothly recovered from operation.Compared with pre-nutrition,CD3,CD4 and NK were significantly increased and CD8 was significantly decreased in pre-operative 1 day.Synchronously,CD4/CD8 was significantly increased in EIN group,and its CD3 and CD4 was higher than EN group.Although cellular immune function was inhibited in postoperative 1 day,CD3 and NK of EIN group was higher than EN group.Cellular immune function began to recover from postoperative 14 day.Furthermore EIN and EN group obtained notable recovery on cellular immune function in postoperative 21 and 28 day respectively.Compared with pre-nutrition,all patients had higher level of lgA in pre-operative 1 day.At the time of postoperative 1,7,14,21 and 28 day,lgA was higher in EIN group than EN group.40 patients showed no complications such as flare and fistula inflammatory effusion and no enteral nutrition related complications in terms of obvious abdominal pain,diarrhea,abdominal distension.Conclusions Compared with regular enteral nutrition,enteral immunonutrition has advantages in relieving serious immune suppression,up-regulating cell immunity and humoral immunity.Fine nursing cares such as psychological nursing,perfect plan and finding the early complications of nutrition are the essentials for successful enteral nutri tion application. Key words: Panereatoduodenectomy;  Immune function;  Enteral Nutrition;  Immununutrition; Nursing

Prospective randomized study on perioperative enteral immunonutrition in laparoscopic colorectal surgery

Perioperative nutrition for patients undergoing colon surgery seems to be effective in reducing catabolism and improving immunologic parameters. A relatively low-fiber and highly absorbable diet may facilitate the intestinal cleansing and loop relaxation fundamental for laparoscopic surgery with a lower dose of iso-osmotic laxative. From 1 February 2004 to 30 July 2005, 28 patients referred to our unit with colon disease (neoplasms and diverticular disease) amenable to laparoscopic surgery were prospectively randomized into two groups of 14 patients each. For 6 days preoperatively, the patients in group 1 were given 750 ml/day of a diet enriched with arginine, omega-3 fatty acids, and ribonucleic acid (RNA) associated with low-fiber foods. They had 1 day of intestinal preparation with 3 l of iso-osmotic laxative. On postoperative day 2, they were fed orally with the same diet. The patients in group 2 preoperatively received a low-fiber diet. They had 2 days of preparation with iso-osmotic laxative (3 l/day). On postoperative day 3, oral nutrition was restored. Intraoperatively, we evaluated loop relaxation and intestinal cleanliness. Clinical trends were monitored in both groups, as well as adverse reactions to early nutrition. The nutritional (albumin, prealbumin) and immunologic (lymphocyte subpopulations, immunoglobulins) biohumoral parameters were evaluated at the first visit, on the day before surgery, on postoperative day 7, and 1 month after surgery. The two groups did not differ in terms of age, gender, distribution of disease, or baseline anthropometric, biohumoral, or immunologic parameters. There was a significant increase in CD4 lymphocytes on the day before surgery as compared with baseline parameters (p < 0.05) in group 1, but not in group 2. There was no statistically significant difference between the two groups in intestinal loop relaxation or cleanliness or in postoperative infectious complications. Perioperative immunonutrition proved to be safe and useful in increasing the perioperative immunologic cell response. It may contribute toward improving the preparation and relaxation of the intestinal loops despite the shorter intestinal preparation.

Effects of perioperative enteral immunonutrition on nutritional status, immunity and inflammatory response of elderly patients

To evaluate the effects of perioperative enteral immunonutrition on the nutritional status, immunity, and inflammatory response of the elderly patients. Eighty malnourished patients aged over 60 with malignant gastrointestinal tumors undergoing radical surgery were randomly divided into 2 groups: experimental group (immunonutrition group, n = 37), and control group (n = 43). In the experimental group Supportan and glutamine, with the calorific value of 125.4 kJ.kg(-1).d(-1), were given orally or by nasointestinal tube for 5 days before operation, through jejunostomy or nasointestinal tube during operation, and then through nasointestinal tube since the day 2 to day 9 after post-operationally. In the control group Nutrition with the same amount of calorific value was given in the same manner as mentioned above. Peripheral blood samples were collected 5 and 1 days pre-operationally, and 1 and 9 days post-operatively to examine the serum albumin (ALB), prealbumin (PA), transferrin (TFN), CD3, CD4, CD8, CD4/CD8, immunoglobulin (Ig) G, IgA, IgM, and C-reactive protein (CRP). Nine days after operation, the serum TFN was 2.18 g/L +/- 0.29 g/L, PA was 0.23 g/L +/- 0.09 g/L, CD4 was 33.8% +/- 5.4%, CD4/CD8 was 1.17 +/- 0.12, and IgG was 13.2 g/L +/- 1.8 g/L. all significantly higher than those of the control group (1.95 g/L +/- 0.28 g/L, 0.19 g/L +/- 0.03 g/L, 31.1% +/- 5.2%, 1.05 +/- 0.10, and 12.11 g/L +/- 1.53 g/L respectively, all P < 0.05). Perioperative enteral immunonutrition improves the nutritional status and immune function, und reduces the acute inflammatory response of elderly patients.

Impact of Perioperative Enteral Immunonutrition in Major Head and Neck Malignancies

Impact of Perioperative Enteral Immunonutrition in Major Head and Neck Malignancies

P.68 Modulation of the early post-operative immune response by perioperative enteral immunonutrition in surgical patients

P.68 Modulation of the early post-operative immune response by perioperative enteral immunonutrition in surgical patients

Perioperative enteral immunonutrition in surgicaL patients

perioperative enteral immunonutrition in surgicaL patients