Effect of enteral immunonutrition as a nutritional strategy in hospitalized cancer patients undergoing major gastrointestinal surgery: systematic review and meta-analysis.
Effect of enteral immunonutrition as a nutritional strategy in hospitalized cancer patients undergoing major gastrointestinal surgery: systematic review and meta-analysis
DOI:
https://doi.org/10.12873/444recobaKeywords:
immuno-nutrition, arginine, glutamine, omega-3, nucleotidesAbstract
Introduction: Oncological patients undergoing gastric or colon surgery with malnutrition may present alterations related to the inflammatory response and post-operative complications.
Objective: The aim of the following article is to determine, based on a systematic review with meta-analysis, the effect of enteral immunonutrition (arginine, glutamine, omega-3 and nucleotides) as a nutritional strategy in hospitalised cancer patients undergoing major gastrointestinal surgery to reduce post-operative infectious complications and modify changes in the inflammatory response.
Material and Methods: An exhaustive search was conducted in Spanish, English and Portuguese for the Medline databases through Ovid, Cochrane (Central), Scopus, Web of Science, EMBASE, Google Scholar and Trip Data Base. Duplicate filtering was performed by two reviewers using the Rayyan tool and data extraction with risk of bias assessment using the ROB-2 tool. Meta-analyses were performed with fixed effects models and publication bias assessment using funnel plots.
Results: 18 international randomised clinical trials (RCTs) (5.5 % developed in the Americas, 50 % in Asia and 44.5 % in Europe) were used for the construction of the systematic review. For enteral immunonutrition compared to standard enteral nutrition a low level of certainty was found for the outcomes of post-operative complications due to infections (RR 0.74 CI 95%; 0.60-0.90, p=0.003; I2=12%, random effects model) in patients with gastric and colon cancer.
Conclusions: Enteral immunonutrition may have little to no effect on the occurrence of infectious post-operative complications in the oncology patient with major gastrointestinal surgeries.
References
International Agency for Rearch on Cancer. Iarc.fr. [citado el 17 de agosto de 2024]. All cancers Source: Glocan 2020 - World Health Organization . Disponible en: https://gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf
Ocón MJ, Luengo LM, Virizuela JA, Álvarez J, Jiménez P, Cervera M, et al. Nutritional support and parenteral nutrition in cancer patients: An expert consensus report. Endocrinol Diabetes Nutr. 2018;65:17–23.
Vargas-Arce Y, Abarca-Gómez L. Prevalencia de la caquexia oncológica en pacientes a nivel de atención primaria: un enfoque paliativo. Acta Med Costarric. 2016;58(4):171–7.
Correa J, Figueroa J, Castaño R, Madrid J, Calle M, Sanbria A. Principios de cirugía oncológica. Rev Colomb. 2016;31:185–96.
Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition. 2021;40(5):2898–913.
De las Peñas R, Majem M, Perez-Altozano J, Virizuela JA, Cancer E, Diz P, et al. SEOM clinical guidelines on nutrition in cancer patients (2018). Clinical and Translational Oncology. 2019;21(1):87–93.
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017;36(1):11–48.
Singer P, Reintam A, Berger M, Alhazzani W, Calder P, Casaer M, et al. ESPEN Guideline ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2019;38(1):48–79.
Nivaldo B de P. Consenso nacional de nutrição oncológica. Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). 2016;2(2):1–114.
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition. 2021;40(7):4745–61.
Bermúdez C, Sanabria Á, Ayala J, Becerra A, Chona M, Colpas L, et al. Inmunonutrición perioperatoria. Consenso de la Asociación Colombiana de Nutrición Clínica. Revista de Nutrición Clínica y Metabolismo. 2019;2(1):15–28.
González L, Orella Duré Z, Villalba W, Encina W, Arandia J, Arandia R, et al. Efecto de los protocolos perioperatorios de recuperación mejorada y convencional sobre la glicemia y el porcentaje de linfocitos en pacientes con cáncer colorrectal en el Instituto Nacional del Cáncer “Prof. Dr. Manuel Riveros”. Cir parag. 2019;44(1):19–23.
Zhang B, Najarali Z, Ruo L, Solis N, Valencia M, Sanchez M, et al. Effect of Perioperative Nutritional Supplementation on Postoperative Complications-Systematic Review and Meta-Analysis. Journal of Gastrointestinal Surgery. 2019;23(8):1682–93.
Pinzón O, Morales M, Kling J, Ariza J. Inmunonutrición, cirugía y oncología: un modelo de atención nutricional basado en la evidencia. Nutrición Clínica y Dietética Hospitalaria. 2022;42(3):68–78.
Higgins J, Green S. Manual Cochrane de revisiones sistemáticas de intervenciones. Vol. 5. 2011. 1–639 p.
Moraga J, Cartes-Velásquez R. Pautas de chequeo, parte II: Quorom y Prisma*. Rev Chil Cir. 2015;67(3):325–30.
Sanabria A, Rigau D, Rotaeche R, Selva A, Marzo-Castillejo M, Alonso-Coello P. Sistema GRADE: Metodología para la realización de recomendaciones para la práctica clínica. Aten Primaria. 2015;47(1):48–55.
Feijó PM, Rodrigues VD, Viana MS, Dos Santos MP, Abdelhay E, Viola JP, et al. Effects of ω-3 supplementation on the nutritional status, immune, and inflammatory profiles of gastric cancer patients: A randomized controlled trial. Nutrition. 2019;61:125–31.
Fujitani K, Tsujinaka T, Fujita J, Miyashiro I, Imamura H, Kimura Y, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. British Journal of Surgery. 2012;99(5):621–9.
Ida S, Hiki N, Cho H, Sakamaki K, Ito S, Fujitani K, et al. Randomized clinical trial comparing standard diet with perioperative oral immunonutrition in total gastrectomy for gastric cancer. British Journal of Surgery. 2017;104(4):377–83.
Okamoto Y, Okano K, Izuishi K, Usuki H, Wakabayashi H, Suzuki Y. Attenuation of the systemic inflammatory response and infectious complications after gastrectomy with preoperative oral arginine and ω-3 fatty acids supplemented immunonutrition. World J Surg. 2009;33(9):1815–21.
Chen DW, Fei ZW, Zhang YC, Ou JM, Xu J. Role of enteral immunonutrition in patients with gastric carcinoma undergoing major surgery. Asian J Surg. 2005;28(2):121–4.
Liu H, Ling W, Shen ZY, Jin X, Cao H. Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy. J Dig Dis. 2012;13(8):401–6.
Zhao H, Zhao H, Wang Y, Jing H, Ding Q, Xue J. Randomized clinical trial of arginine-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing gastric cancer surgery. J Cancer Res Clin Oncol. 2013;139(9):1465–70.
Li K, Xu Y, Hu Y, Liu Y, Chen X, Zhou Y. Effect of Enteral Immunonutrition on Immune, Inflammatory Markers and Nutritional Status in Gastric Cancer Patients Undergoing Gastrectomy: A Randomized Double-Blinded Controlled Trial. Journal of Investigative Surgery. 2020;33(10):950–9.
Ma C, Tsai H, Su W, Sun L, Shih Y, Wang J. Combination of arginine, glutamine, and omega-3 fatty acid supplements for perioperative enteral nutrition in surgical patients with gastric adenocarcinoma or gastrointestinal stromal tumor (GIST): A prospective, randomized, double-blind study. J Postgrad Med. 2018;64(3):155–63.
Horie H, Okada M, Kojima M, Nagai H. Favorable effects of preoperative enteral immunonutrition on a surgical site infection in patients with colorectal cancer without malnutrition. Surg Today. 2006;36(12):1063–8.
Scislo L, Pach R, Nowak A, Walewska E, Gadek M, Brandt P, et al. The Impact of Postoperative Enteral Immunonutrition on Postoperative Complications and Survival in Gastric Cancer Patients–Randomized Clinical Trial. Nutr Cancer. 2018;70(3):453–9.
Marano L, Porfidia R, Pezzella M, Grassia M, Petrillo M, Esposito G, et al. Clinical and immunological impact of early postoperative enteral immunonutrition after total gastrectomy in gastric cancer patients: A prospective randomized study. Ann Surg Oncol. 2013;20(12):3912–8.
Klek S, Scislo L, Walewska E, Choruz R, Galas A. Enriched enteral nutrition may improve short-term survival in stage IV gastric cancer patients: A randomized, controlled trial. Nutrition. 2017;36:46–53.
Farreras N, Artigas V, Cardona D, Rius X, Trias M, González JA. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clinical Nutrition. 2005;24(1):55–65.
Manzanares M, Martín J, Amo M, Casanova D. Estudio prospectivo y randomizado sobre inmunonutrición oral preoperatoria en pacientes intervenidos por cáncer colorrectal: estancia hospitalaria y costos sanitarios. Cirugía y Cirujanos. 2017;85(5):393–400.
Finco C, Magnanini P, Sarzo G, Vecchiato M, Luongo B, Savastano S, et al. Prospective randomized study on perioperative enteral immunonutrition in laparoscopic colorectal surgery. Surgical Endoscopy and Other Interventional Techniques. 2007;21(7):1175–9.
Sorensen LS, Thorlacius-Ussing O, Schmidt EB, Rasmussen HH, Lundbye-Christensen S, Calder PC, et al. Randomized clinical trial of perioperative omega-3 fatty acid supplements in elective colorectal cancer surgery. British Journal of Surgery. 2014;101(2):33–42.
Moya P, Soriano-Irigaray L, Ramirez J, Garcea A, Blasco O, Blanco F, et al. Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol. Medicine. 2016;95(21):1–11.
Peters E, Smeets BJJ, Nors J, Back C., Funder J., Sommer T, et al. Perioperative lipid-enriched enteral nutrition versus standard care in patients undergoing elective colorectal surgery (SANICS II): a multicentre, double-blind, randomised controlled trial. Lancet Gastroenterol Hepatol. 2018;3(4):242–51.
Yu K, Zheng X, Wang G, Liu M, Li Y, Yu P, et al. Immunonutrition vs Standard Nutrition for Cancer Patients: A Systematic Review and Meta-Analysis (Part 1). Journal of Parenteral and Enteral Nutrition. 2020;44(5):742–67.
Adiamah A, Skořepa P, Weimann A, Lobo D. The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis. Ann Surg. 2019;270(2):247–56.
Cheng Y, Zhang J, Zhang L, Wu J, Zhan Z. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol. 2018;18(1):11.
Song GM, Tian X, Liang H, Yi LJ, Zhou JG, Zeng Z, et al. Role of enteral immunonutrition in patients undergoing surgery for gastric cancer: A systematic review and meta-analysis of randomized controlled trials. Medicine . 2015;94(31).
D’Ignazio A, Kabata P, Ambrosio MR, Polom K, Marano L, Spagnoli L, et al. Preoperative oral immunonutrition in gastrointestinal surgical patients: How the tumour microenvironment can be modified. Clin Nutr ESPEN. 2020;38:153–9.
Rinninella E, Cintoni M, Raoul P, Pozzo C, Strippoli A, Bria E, et al. Effects of nutritional interventions on nutritional status in patients with gastric cancer: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN. 2020;38:28–42.
Evans DC, Corkins MR, Malone A, Miller S, Mogensen KM, Guenter P, et al. The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper. Nutrition in Clinical Practice. 2021;36(1):22–8.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Nutrición Clínica y Dietética Hospitalaria
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Los lectores pueden utilizar los textos publicados de acuerdo con la definición BOAI (Budapest Open Access Initiative)
