1.
The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy.
Jabłońska, B, Mrowiec, S
Nutrients. 2020;(9)
Abstract
Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgical procedures in abdominal surgery. Malnutrition and immune dysfunction in patients with pancreatic cancer (PC) may lead to a higher risk of postoperative infectious complications. Although immunonutrition (IN) is recommended for enhanced recovery after surgery (ERAS) in patients undergoing PD for 5-7 days perioperatively, its role in patients undergoing pancreatectomy is still unclear and controversial. It is known that the proper surgical technique is very important in order to reduce a risk of postoperative complications, such as a pancreatic fistula, and to improve disease-free survival in patients following PD. However, it has been proven that IN decreases the risk of infectious complications, and shortens hospital stays in patients undergoing PD. This is a result of the impact on altered inflammatory responses in patients with cancer. Both enteral and parenteral, as well as preoperative and postoperative IN, using various nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides, is administered. The most frequently used preoperative oral supplementation is recommended. The aim of this paper is to present the indications and benefits of IN in patients undergoing PD.
2.
Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes.
Barajas-Galindo, DE, Vidal-Casariego, A, Pintor-de la Maza, B, Fernández-Martínez, P, Ramos-Martínez, T, García-Arias, S, Hernández-Moreno, A, Urioste-Fondo, A, Cano-Rodríguez, I, Ballesteros-Pomar, MD
Endocrinologia, diabetes y nutricion. 2020;(1):13-19
Abstract
BACKGROUND Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS). METHODS A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded. RESULTS In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p=0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula. CONCLUSIONS Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery.
3.
Combination of arginine, glutamine, and omega-3 fatty acid supplements for perioperative enteral nutrition in surgical patients with gastric adenocarcinoma or gastrointestinal stromal tumor (GIST): A prospective, randomized, double-blind study.
Ma, C, Tsai, H, Su, W, Sun, L, Shih, Y, Wang, J
Journal of postgraduate medicine. 2018;(3):155-163
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Abstract
BACKGROUND Perioperative enteral nutrition (EN) enriched with immune-modulating substrates is preferable for patients undergoing major abdominal cancer surgery. In this study, perioperative EN enriched with immune-modulating nutrients such as arginine, glutamine, and omega-3 fatty acids was evaluated for its anti-inflammatory efficacy in patients with gastric adenocarcinoma or gastrointestinal stromal tumor (GIST) receiving curative surgery. MATERIALS AND METHODS This prospective, randomized, double-blind study recruited 34 patients with gastric adenocarcinoma or gastric GIST undergoing elective curative surgery. These patients were randomly assigned to the study group, receiving immune-modulating nutrient-enriched EN, or the control group, receiving standard EN from 3 days before surgery (preoperative day 3) to up to postoperative day 14 or discharge. Laboratory and inflammatory parameters were assessed on preoperative day 3 and postoperative day 14 or at discharge. Adverse events (AEs) and clinical outcomes were documented daily and compared between groups. RESULTS No significant differences were observed between the two groups in selected laboratory and inflammatory parameters, or in their net change, before and after treatment. AEs and clinical outcomes, including infectious complications, overall complications, time to first bowel action, and length of hospital stay after surgery, were comparable between treatment groups (all P > 0.05). CONCLUSION Immune-modulating nutrient-enriched EN had no prominent immunomodulation effect compared with that of standard EN.
4.
Efficacy of arginine-enriched enteral formulas for the healing of pressure ulcers: a systematic review.
Liu, P, Shen, WQ, Chen, HL
Journal of wound care. 2017;(6):319-323
Abstract
OBJECTIVE Arginine improves healing and modulates inflammation and the immune response. This systematic review aimed to assess the effect of arginine-enriched enteral formulas in pressure ulcer (PU) healing. METHOD Systematic computerised searches of PubMed, Web of Knowledge, Scopus, ENTRAL and CINAHL databases were performed from their inception to 20 January 2016. Randomised controlled trials (RCTs) were included in this systematic review. We used the Jadad scale as a quality assessment tool. RESULTS There were seven RCTs with 369 patients included in this systematic review; four RCTs assessed healing by PU area reduction. All of them reported arginine-enriched enteral nutrition led to a significant improved PU healing compared with standard hospital diet in 2-12 weeks follow-up. Among these four RCTs, one enrolled malnourished patients, one enrolled non-malnourished patients, and the other two studies did not restrict the nutritional status of the patients. Using the Pressure Ulcer Scale for Healing (PUSH) four RCTs assessed healing of PU, all reporting arginine-enriched enteral nutrition resulted in a significant PUSH score improvement compared with control at follow-up. Using the Pressure Sore Status Tool (PSST) one RCT assessed healing of PUs, finding patients receiving arginine had the lowest PSST scores compared with controls. An RCT compared healing with two doses of arginine (4.5g versus 9g), but no difference was found between the doses. CONCLUSION Evidence showed that arginine-enriched enteral nutrition led to a significant improvement in PU healing. It was effective not only in malnourished patients, but also in non-malnourished patients.