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Preoperative immunonutrition in patients undergoing liver resection: a prospective randomized trial

Preoperative immunonutrition in patients undergoing liver resection: a prospective randomized trial
Preoperative immunonutrition in patients undergoing liver resection: a prospective randomized trial
BACKGROUND Preoperative supplementation with immunonutrients, including arginine and n-3 fatty acids, has been shown in a number of systematic reviews to reduce infectious complications in patients who have undergone gastrointestinal surgery. Limited information, however, is available on the benefits of nutritional supplementation enriched with arginine and n-3 fatty acids in patients undergoing liver resection. AIM To evaluate the effects of preoperative nutritional supplementation enriched with arginine and n-3 fatty acids on inflammatory and immunologic markers and clinical outcome in patients undergoing liver resection. METHODS Thirty-four patients undergoing liver resection were randomized to either five days of preoperative Impact® [1020 kcal/d, immunonutrition (IMN) group], or standard care [no supplementation, standard care (STD) group]. Nutritional status was measured at study entry by subjective global assessment (SGA). Functional assessments (grip strength, fatigue and performance status) were carried out at study entry, on the day prior to surgery, and on postoperative day (POD) 7 and 30. Inflammatory and immune markers were measured at study entry, on the day prior to surgery, and POD 1, 3, 5, 7, 10 and 30. Postoperative complications were recorded prospectively until POD30. RESULTS A total of 32 patients (17 IMN and 15 STD) were analysed. All except four patients were SGA class A. The plasma ratio of (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid was higher in IMN patients on the day prior to surgery and POD 1, 3, 5 and 7 (P < 0.05). Plasma interleukin (IL)-6 concentrations were elevated in the IMN group (P = 0.017 for POD7). No treatment effect was detected for functional measures, immune response (white cell count and total lymphocytes) or markers of inflammation (C-reactive protein, tumour necrosis factor-α, IL-8, IL-10). There were 10 patients with infectious complications in the IMN group and 4 in the STD group (P = 0.087). Median hospital stay was 9 (range 4–49) d in the IMN group and 8 (3-34) d in the STD group (P = 0.476). CONCLUSION In well-nourished patients undergoing elective liver resection, this study failed to show any benefit of preoperative immunonutrition.
305-317
Russell, Kylie
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Zhang, Han-Guang
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Gillanders, Lyn K
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Bartlett, Adam SJR
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Fisk, Helena, Lucy
38c7f1f0-5dfc-4f71-aa0f-ec4f0e5839f3
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Swan, Peter J
26c19891-32fc-472a-ad69-d9fc0af185d8
Plank, Lindsay D
10fc727f-e386-4d64-ac69-7eeff6442dc0
Russell, Kylie
22a4018f-e0f7-4f6d-99b9-90aac11bdc8a
Zhang, Han-Guang
bc35f77b-5b65-4b24-898a-d581cae784d4
Gillanders, Lyn K
f0def3ca-6539-4446-9c77-7b1f627eb773
Bartlett, Adam SJR
304876d8-3d04-41ef-b0fa-98db16a33b10
Fisk, Helena, Lucy
38c7f1f0-5dfc-4f71-aa0f-ec4f0e5839f3
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Swan, Peter J
26c19891-32fc-472a-ad69-d9fc0af185d8
Plank, Lindsay D
10fc727f-e386-4d64-ac69-7eeff6442dc0

Russell, Kylie, Zhang, Han-Guang, Gillanders, Lyn K, Bartlett, Adam SJR, Fisk, Helena, Lucy, Calder, Philip, Swan, Peter J and Plank, Lindsay D (2019) Preoperative immunonutrition in patients undergoing liver resection: a prospective randomized trial. World Journal of Hepatology, 11 (3), 305-317. (doi:10.4254/wjh.v11.i3.305).

Record type: Article

Abstract

BACKGROUND Preoperative supplementation with immunonutrients, including arginine and n-3 fatty acids, has been shown in a number of systematic reviews to reduce infectious complications in patients who have undergone gastrointestinal surgery. Limited information, however, is available on the benefits of nutritional supplementation enriched with arginine and n-3 fatty acids in patients undergoing liver resection. AIM To evaluate the effects of preoperative nutritional supplementation enriched with arginine and n-3 fatty acids on inflammatory and immunologic markers and clinical outcome in patients undergoing liver resection. METHODS Thirty-four patients undergoing liver resection were randomized to either five days of preoperative Impact® [1020 kcal/d, immunonutrition (IMN) group], or standard care [no supplementation, standard care (STD) group]. Nutritional status was measured at study entry by subjective global assessment (SGA). Functional assessments (grip strength, fatigue and performance status) were carried out at study entry, on the day prior to surgery, and on postoperative day (POD) 7 and 30. Inflammatory and immune markers were measured at study entry, on the day prior to surgery, and POD 1, 3, 5, 7, 10 and 30. Postoperative complications were recorded prospectively until POD30. RESULTS A total of 32 patients (17 IMN and 15 STD) were analysed. All except four patients were SGA class A. The plasma ratio of (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid was higher in IMN patients on the day prior to surgery and POD 1, 3, 5 and 7 (P < 0.05). Plasma interleukin (IL)-6 concentrations were elevated in the IMN group (P = 0.017 for POD7). No treatment effect was detected for functional measures, immune response (white cell count and total lymphocytes) or markers of inflammation (C-reactive protein, tumour necrosis factor-α, IL-8, IL-10). There were 10 patients with infectious complications in the IMN group and 4 in the STD group (P = 0.087). Median hospital stay was 9 (range 4–49) d in the IMN group and 8 (3-34) d in the STD group (P = 0.476). CONCLUSION In well-nourished patients undergoing elective liver resection, this study failed to show any benefit of preoperative immunonutrition.

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More information

Accepted/In Press date: 16 March 2019
e-pub ahead of print date: 27 March 2019
Published date: 27 March 2019

Identifiers

Local EPrints ID: 432594
URI: http://eprints.soton.ac.uk/id/eprint/432594
PURE UUID: 25af3b1b-745e-482f-b079-9bd028bebdad
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X

Catalogue record

Date deposited: 19 Jul 2019 16:38
Last modified: 22 Nov 2021 02:39

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Contributors

Author: Kylie Russell
Author: Han-Guang Zhang
Author: Lyn K Gillanders
Author: Adam SJR Bartlett
Author: Helena, Lucy Fisk
Author: Philip Calder ORCID iD
Author: Peter J Swan
Author: Lindsay D Plank

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