Preop immune-modulating nutrition improves outcomes after GI-cancer surgery

Last Updated: 2019-03-25

By Will Boggs MD

NEW YORK (Reuters Health) - Preoperative immune-modulating nutrition (IMN) in patients undergoing surgery for gastrointestinal cancer reduces the risk of infectious complications and shortens hospital stays, according to a new systematic review and meta-analysis.

"Given good tolerance of these supplements, a lack of side effect profile, and the ready availability and affordability of these supplements, they should be recommended in routine practice for patients undergoing surgery for gastrointestinal cancer, and in particular for those patients with proven malnutrition," Dr. Dileep N. Lobo of Nottingham University Hospitals NHS Trust in the U.K. told Reuters Health.

IMN, or pharmaconutrition, involves the use of selected nutrients to improve nutritional status and to modulate host immune systems and inflammatory response to stress. The most frequently used immune-modulating nutrients include various combinations of arginine, omega-3 fatty acids, nucleotides and glutamine.

Dr. Lobo's team investigated the impact of oral or enteral IMN administered a minimum of three days in the preoperative period on postoperative outcomes in patients undergoing surgery for gastrointestinal cancer in 16 studies that enrolled 1,387 patients.

All studies used the nutrition formula "Impact" (from Novartis/Nestle), which contains omega-3 fatty acids, arginine and nucleotides.

Infectious complications occurred in 18.6% (133/715) of patients in the IMN group, compared with 29.31% (199/672) of patients in the control group, which translated into 48% lower odds of infectious complications after preoperative treatment with IMN (P<0.0001).

Hospital stays were 1.57 days shorter in the IMN group on average, also a significant finding, the team reports in the Annals of Surgery, online February 26.

The IMN and control groups did not differ significantly in the rate of noninfectious complications (20% vs. 21%, respectively) or in mortality rates (1.03% vs. 2.56%, respectively).

"The evidence to support the use of IMN in gastrointestinal cancer is an important and significant finding," Dr. Lobo said. "However, it will be important for adequately powered future studies to evaluate benefit in different types of gastrointestinal cancers separately to reduce the clinical heterogeneity in the currently available literature. This will allow us to explore and quantify the benefit of IMN in, say, pancreatic cancer compared with colorectal cancer, for example."

SOURCE: https://bit.ly/2HtdEt2

Ann Surg 2019.