Skip to main content

Advertisement

SpringerLink
Log in

Comparison of Perioperative Standard and Immunomodulating Enteral Nutrition in Patients Received Major Abdominal Cancer Surgery: a Prospective, Randomized, Controlled Clinical Trial

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The aim of this study was to compare the effects of standard and immunomodulating enteral nutrition on the clinical outcomes of the patients undergoing major abdominal cancer surgery. Patients who underwent a major elective abdominal cancer surgery in our clinic were randomly assigned preoperatively to two groups according to enteral nutritional intervention; Standard (ST) or Immunomodulating (IM) group. The patients who were randomized to ST and IM groups received Resource® 2.0 fiber and OraI Impact® RTD 7 days prior to surgery and 30 days after surgery, respectively. The outcome variables were as follows; infections (surgical site infection, pneumonia, abdominal abscess or septicemia), non-infectious complications (wound dehiscence, anastomotic leak, adult respiratory distress syndrome (ARDS), multi-organ failure), need for intensive care unit admission, need for re-operation, length of hospital stay, and hospital mortality. A total of 78 patients were randomized (n = 39 in each group). Forty-five (58%) of patients were male and mean age was 62.9 ± 13.4 (25–85). The mean pre-operative Body Mass Index (BMI) and Nutritional Risk Screening (NRS-2002) scores were 26.5 ± 5.4 and 2.3 ± 1.1, respectively. There were no significant differences in gender, age, BMI, and NRS-2002 scores between groups (p ≥ 0.05). ASA scores, surgical interventions also were similar in two groups. Rate of surgical site infection in groups ST and IM was 72% (n = 28) and 15% (n = 6), (p < 0.001). Rate of pneumonia in groups ST and IM was 25% (n = 10) and 0% (n = 0), (p < 0.001). Rate of urinary tract infection in groups ST and IM was 33.3% (n = 13) and 5.1% (n = 2), (p < 0.03). Length of hospital stay in groups ST and IM was 8.4 ± 4.8 and 6.1 ± 1.4, respectively (p < 0,003). There were no significant differences in other outcome variables between groups (p ≥ 0.05, for all comparisons). Perioperative immunomodulating enteral nutrition may reduce the incidence of surgical site infection, pneumonia, urinary tract infection and length of hospital stays in patients who received abdominal cancer surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fearon KC, Ljungqvist O, Von Meyenfeldt M et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24(3):466–477

    Article  CAS  Google Scholar 

  2. Parks L, Routt M, De Villiers A (2018) Enhanced recovery after surgery. J Adv Pract Oncol 9(5):511–519

    PubMed  PubMed Central  Google Scholar 

  3. Jeong O, Kim HG (2019) Implementation of enhanced recovery after surgery (ERAS) program in perioperative Management of Gastric Cancer Surgery: a Nationwide survey in Korea. J Gastric Cancer 19(1):72–82

    Article  Google Scholar 

  4. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36(1):11–48

    Article  Google Scholar 

  5. Braga M, Gianotti L, Radaelli G et al (1999) Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blind phase 3 trial. Arch Surg 134(4):428–433

    Article  CAS  Google Scholar 

  6. Cerantola Y, Grass F, Cristaudi A et al (2011) Perioperative nutrition in abdominal surgery: recommendations and reality. Gastroenterol Res Pract 2011:739347

    Article  Google Scholar 

  7. Lohsiriwat V (2019) Learning curve of enhanced recovery after surgery program in open colorectal surgery. World J Gastrointest Surg 11(3):169–178

    Article  Google Scholar 

  8. Waitzberg DL, Saito H, Plank LD, Jamieson GG, Jagannath P, Hwang TL, Mijares JM, Bihari D (2006) Postsurgical infections are reduced with specialized nutrition support. World J Surg 30(8):1592–1604

    Article  Google Scholar 

  9. Adiamah A, Skořepa P, Weimann A, Lobo DN (2019) The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal Cancer: a systematic review and meta-analysis. Ann Surg 270(2):247–256

    Article  Google Scholar 

  10. Strickland A, Brogan A, Krauss J, Martindale R, Cresci G (2005) Is the use of specialized nutritional formulations a cost-effective strategy? A national database evaluation. JPEN J Parenter Enteral Nutr 29(1 Suppl):S81–S91

    PubMed  Google Scholar 

  11. Bozzetti F, Forbes A (2009) The ESPEN clinical practice guidelines on parenteral nutrition: present status and perspectives for future research. Clin Nutr 28(4):359–364

    Article  Google Scholar 

  12. Weimann A, Braga M, Carli F et al (2017) ESPEN guideline: clinical nutrition in surgery. Clin Nutr 36(3):623–650

    Article  Google Scholar 

  13. Braga M, Gianotti L, Gentilini O, Liotta S, di Carlo V (2002) Feeding the gut early after digestive surgery: results of a nine-year experience. Clin Nutr 21(1):59–65

    Article  CAS  Google Scholar 

  14. Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC (2019) ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 38(1):10–47

    Article  Google Scholar 

  15. Cerantola Y, Hübner M, Grass F, Demartines N, Schäfer M (2011) Immunonutrition in gastrointestinal surgery. Br J Surg 98(1):37–48

    Article  CAS  Google Scholar 

  16. Kompan L, Vidmar G, Spindler-Vesel A et al (2004) Is early enteral nutrition a risk factor for gastric intolerance and pneumonia? Clin Nutr 23(4):527–532

    Article  Google Scholar 

  17. Daly JM, Redmond HP, Gallagher H (1992) Perioperative nutrition in cancer patients. JPEN J Parenter Enteral Nutr 16(6 Suppl):100S–105S

    Article  CAS  Google Scholar 

  18. Marik PE, Flemmer M (2012) Immunonutrition in the surgical patient. Minerva Anestesiol 78(3):336–342

    CAS  PubMed  Google Scholar 

  19. Marik PE, Zaloga GP (2010) Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature. JPEN J Parenter Enteral Nutr 34(4):378–386

    Article  Google Scholar 

  20. Pacelli F, Bossola M, Papa V, Malerba M, Modesti C, Sgadari A et al (2001) EN-TPN Study Group. Enteral vs parenteral nutrition after major abdominal surgery: an even match. Arch Surg 136(8):933–936

    Article  CAS  Google Scholar 

  21. Marimuthu K, Varadhan KK, Ljungqvist O, Lobo DN (2012) A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery. Ann Surg 255(6):1060–1068

    Article  Google Scholar 

  22. Klek S, Szybinski P, Szczepanek K (2014) Perioperative immunonutrition in surgical cancer patients: a summary of a decade of research. World J Surg 38(4):803–812

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ali Osman Sönmez Oncology Hospital Clinic of General Surgery, Bursa, Turkey

    Serkan Fatih Yeğen

  2. Health Sciences University Mehmet Akif Inan Training and Research Hospital Clinic of General Surgery, Şanlıurfa, Turkey

    Mehmet Tolga Kafadar

  3. Health Sciences University Derince Training and Research Hospital Clinic of General Surgery, Kocaeli, Turkey

    Mehmet Ali Gök

Authors
  1. Serkan Fatih Yeğen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Tolga Kafadar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Ali Gök
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Tolga Kafadar.

Ethics declarations

Informed Consent

Informed consents were obtained from the patients.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yeğen, S.F., Kafadar, M.T. & Gök, M.A. Comparison of Perioperative Standard and Immunomodulating Enteral Nutrition in Patients Received Major Abdominal Cancer Surgery: a Prospective, Randomized, Controlled Clinical Trial. Indian J Surg 82, 828–834 (2020). https://doi.org/10.1007/s12262-020-02114-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-020-02114-0

Keywords

Search

Navigation