Systematic review on immunonutrition in partial pancreatoduodenectomy
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SYSTEMATIC REVIEWS AND META-ANALYSES
Systematic review on immunonutrition in partial pancreatoduodenectomy Kosei Takagi 1
&
Yuzo Umeda 1 & Ryuichi Yoshida 1 & Takahito Yagi 1 & Toshiyoshi Fujiwara 1
Received: 31 March 2020 / Accepted: 23 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The effect of immunonutrition (IM) on postoperative outcomes has been investigated in gastrointestinal cancer surgery; however, strong evidence regarding IM in partial pancreatoduodenectomy (PD) is lacking. This study evaluated the effect of IM on short-term outcomes in patients undergoing PD. Methods A systematic literature review of randomized controlled trials was conducted to identify the studies investigating the IM effect on outcomes in PD. Random-effects meta-analyses were conducted to calculate the pooled risk ratio (RR). Studies were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results Five studies were included in the meta-analysis. IM was associated with a lower incidence of overall complications (RR 0.74; 95% confidence interval (CI) 0.58, 0.94; P = 0.01; I2 = 0%) and infectious complications (RR 0.60; 95% CI 0.42, 0.84; P = 0.003; I2 = 0%). However, no significant association was noted in the incidence of major complications (RR 0.68; 95% CI 0.41, 1.12; P = 0.13), mortality (RR 0.79; 95% CI 0.16, 3.99; P = 0.78), postoperative pancreatic fistula (RR 0.92, 95% CI 0.59, 1.46; P = 0.74), and delayed gastric emptying (RR 1.09; 95% CI 0.55, 2.15; P = 0.81). Conclusions IM administration in PD can prevent the incidence of overall and infectious complications postoperatively (GRADE recommendation: moderate). However, IM has no impact on major complications, mortality, and PD-specific complications (GRADE recommendation: low). Keywords Immunonutrition . Outcome . Pancreatoduodenectomy . Meta-analysis
Introduction Perioperative nutritional therapies such as enteral nutrition, immunonutrition (IM), and synbiotics are important interventions for improving clinical outcomes of highly invasive procedures such as partial pancreatoduodenectomy (PD) [1]. IM comprising arginine, omega-3 fatty acids, and ribonucleic acid has been reported to modulate immune responses, inflammatory pathways, and gut function after surgery [2]. Systematic reviews have reported the beneficial effects of IM in
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01916-w) contains supplementary material, which is available to authorized users. * Kosei Takagi [email protected] 1
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
gastrointestinal surgery [3–6]. Beneficial effects included improved postoperative clinical outcomes with decrease in the incidence of infectious complications and length of stay (LOS). A recent meta-analysis investigating the effects of IM in
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