To compare postoperative complications in patients with or without preoperative immunonutrition before cystectomy.
A prospective, multicenter, pilot, case–control study was conducted during 6 months. Patients with 7-day preoperative immunonutrition were prospectively included and compared with a retrospective, matched control group without immunonutrition. Early complication rates and the length of hospital stay were analyzed. The bilateral type I error was <0.05; the power was 90 %. Thirty patients in each group were required.
Thirty patients were included in each group, on a comparable basis. In the immunonutrition group, fewer postoperative complications (40 vs. 76.7 %; p = 0.008), less paralytic ileus at D7 (6.6 vs. 33.3 %; p = 0.02), fewer infections (23.3 vs. 60 %; p = 0.008), and in particular less pyelonephritis (16.7 vs. 46.7 %; p = 0.03) occurred. Clavien’s grades for complications were higher in the control group (p = 0.04). Mortality, pulmonary embolism, anastomotic fistulae, and wound dehiscence were similar between two groups. The length of stay was reduced by 3 days in the immunonutrition group.
In this pilot case–control study, immunonutrition is associated with a decrease in postoperative complications, urinary tract infections, Clavien’s grade for complications, and paralytic ileus in patients undergoing cystectomy for bladder cancer. Prospective randomized placebo control studies are needed to confirm these promising results.
This is a preview of subscription content,to check access.
Access this article
Stenzl A, Cowan NC, De Santis M, Kuczyk MA, Merseburger AS, Ribal MJ, Sherif A, Witjes JA (2011) European Association of Urology (EAU). Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 59(6):1009–1018. doi:10.1016/j.eururo.2011.03.023
Zerbib M, Bouchot O, Coloby P (2002) Mortality, morbidity, and functional results of total cystectomy. Prog Urol 12(5):891–911
Ghisolfi-Marque A (2009) Denutrition in the elderly patient with urologic cancer. Prog Urol 19(Suppl 3):S106–S109
Argilés JM (2005) Cancer associated malnutrition. Eur J Oncol Nurs 9(Suppl 2):S39–S50
Dmochowski R, Scarpero H (2007) Surgical outcomes reporting-closer to reality. Eur Urol 52:1306–1308
Mizock BA, Sriram K (2011) Perioperative immunonutrition. Expert Rev Clin Immunol 7(1):1–3
National commission of evaluation of medical device and health technology: Comission’s opinion 4th December 2012, concerning Oral Impact, French High Health Authority
Hübner M, Cerantola Y, Grass F, Bertrand PC, Schäfer M, Demartines N (2012) Preoperative immunonutrition in patients at nutritional risk: results of a double-blinded randomized clinical trial. Eur J Clin Nutr 66(7):850–855
Burden S, Todd C, Hill J, Lal S (2012) Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev 11:CD008879
Mauskopf JA, Candrilli SD, Chevrou-Séverac H, Ochoa JB (2012) Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs. World J Surg Oncol 6(10):136
Giger U, Büchler M, Farhadi J, Berger D, Hüsler J, Schneider H, Krähenbühl S, Krähenbühl L (2007) Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery—a randomized controlled pilot study. Ann Surg Oncol 14(10):2798–2806
Inoue M, Kinoshita K, Sano F, Kobayashi M, Yasuda S, Sowa T, Komatsu T, Fujinaga T, Kato T (2012) Perioperative nutritional support with immune-enhancing diet for surgical closure of open thoracic window. Kyobu Geka 65(7):559–562
Turnock A, Calder PC, West AL, Izzard M, Morton RP, Plank LD (2013) Perioperative immunonutrition in well-nourished patients undergoing surgery for head and neck cancer: evaluation of inflammatory and immunologic outcomes. Nutrients 5(4):1186–1199. doi:10.3390/nu5041186
McClave SA, Lowen CC, Snider HL (1992) Immunonutrition and enteral hyperalimentation of critically ill patients. Dig Dis Sci 37(8):1153–1161
Senkal M, Mumme A, Eickhoff U, Geier B, Späth G, Wulfert D, Joosten U, Frei A, Kemen M (1997) Early postoperative enteral immunonutrition: clinical outcome and cost-comparison analysis in surgical patients. Crit Care Med 25(9):1489–1496
Evoy D, Lieberman MD, Fahey TJ III, Daly JM (1998) Immunonutrition: the role of arginine. Nutrition 14(7–8):611–617
Alexander JW (1998) Immunonutrition: the role of omega-3 fatty acids. Nutrition 14(7–8):627–633
Zheng Y, Li F, Qi B, Luo B, Sun H, Liu S, Wu X (2007) Application of perioperative immunonutrition for gastrointestinal surgery: a meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr 16(Suppl 1):253–257
Braga M, Gianotti L (2005) Preoperative immunonutrition: cost-benefit analysis. JPEN J Parenter Enteral Nutr 29(1 Suppl):S57–S61
De Nunzio C, Cindolo L, Leonardo C, Antonelli A, Ceruti C, Franco G, Falsaperla M, Gallucci M, Alvarez-Maestro M, Minervini A, Pagliarulo V, Parma P, Perdonà S, Porreca A, Rocco B, Schips L, Serni S, Serrago M, Simeone C, Simone G, Spadavecchia R, Celia A, Bove P, Zaramella S, Crivellaro S, Nucciotti R, Salvaggio A, Frea B, Pizzuti V, Salsano L, Tubaro A (2013) Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort. Eur J Surg Oncol 39(7):792–798. doi:10.1016/j.ejso.2013.03.008
Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP Jr, Raghavan D, Crawford ED (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349(9):859–866
Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, Davis R, Stimson CJ Jr, Aghazadeh M, Smith JA Jr, Barocas DA (2011) Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer. J Urol 185(1):90–96. doi:10.1016/j.juro.2010.09.021
Chambrier C, Sztark F (2012 ) French clinical guidelines on perioperative nutrition. Update of the 1994 consensus conference on perioperative artificial nutrition for elective surgery in adults. J Visc Surg 149(5):e325–e336. doi:10.1016/j.jviscsurg.2012.06.006
Lambert JW, Ingham M, Gibbs BB, Given RW, Lance RS, Riggs SB (2013) Using preoperative albumin levels as a surrogate marker for outcomes after radical cystectomy for bladder cancer. Urology 81(3):587–592. doi:10.1016/j.urology.2012.10.055
Maffezzini M, Roth B, Birkhäuser FD, Zehnder P et al (2013) Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial. Eur Urol 63(3):475–482. doi:10.1016/j.eururo.2012.05.052
Cerantola Y, Valerio M, Hubner M, Iglesias K, Vaucher L, Jichlinski P (2013) Are patients at nutritional risk more prone to complications after major urological surgery? J Urol 190(6):2126–2132. doi:10.1016/j.juro.2013.06.111
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
Cite this article
Bertrand, J., Siegler, N., Murez, T. et al. Impact of preoperative immunonutrition on morbidity following cystectomy for bladder cancer: a case–control pilot study. World J Urol 32, 233–237 (2014). https://doi.org/10.1007/s00345-013-1229-6