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Systematic review on immunonutrition in partial pancreatoduodenectomy

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

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).

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Authors and Affiliations

  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

    Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Takahito Yagi & Toshiyoshi Fujiwara

Authors
  1. Kosei Takagi
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  2. Yuzo Umeda
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  3. Ryuichi Yoshida
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  4. Takahito Yagi
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  5. Toshiyoshi Fujiwara
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Contributions

K.T. contributed to the study conception and design, the acquisition of data, the development of the protocol, and the drafting of the manuscript. Y.U. contributed to the analysis and interpretation of the quantitative data, and the drafting of the manuscript. R.Y., T.Y., and T.F. contributed to the development of the protocol and the critical revising of the final draft. All authors have approved the final version.

Corresponding author

Correspondence to Kosei Takagi.

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Ethics approval and consent to participate

No ethical approval or informed consent statement was required for this review article. This study was registered at the University Hospital Medical Information Network (UMIN), registration number UMIN000040383.

Conflict of interest

The authors declare that they have no conflict of interest.

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Supplementary Figure 1

Funnel plots of meta-analyses. (DOCX 98 kb).

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Takagi, K., Umeda, Y., Yoshida, R. et al. Systematic review on immunonutrition in partial pancreatoduodenectomy. Langenbecks Arch Surg 405, 585–593 (2020). https://doi.org/10.1007/s00423-020-01916-w

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  • DOI: https://doi.org/10.1007/s00423-020-01916-w

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