Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Oct;4(5):764-775.
doi: 10.1002/bjs5.50314. Epub 2020 Jun 23.

Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis

F Buzquurz  1   2 , R D Bojesen  1   2 , C Grube  1   2 , M T Madsen  2 , I Gögenur  2
Affiliations
Meta-Analysis

Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis

F Buzquurz et al. BJS Open. 2020 Oct.

Abstract
in English, Spanish

Background: Infectious complications occur in 4-22 per cent of patients undergoing surgical resection of malignant solid tumours. Improving the patient's immune system in relation to oncological surgery with immunonutrition may play an important role in reducing postoperative infections. A meta-analysis was undertaken to evaluate the potential clinical benefits of immunonutrition on postoperative infections and 30-day mortality in patients undergoing oncological surgery.

Methods: PubMed, Embase and Cochrane Library databases were searched to identify eligible studies. Eligible studies had to include patients undergoing elective curative surgery for a solid malignant tumour and receiving immunonutrition orally before surgery, including patients who continued immunonutrition into the postoperative period. The main outcome was overall infectious complications; secondary outcomes were surgical-site infection (SSI) and 30-day mortality, described by relative risk (RR) with trial sequential analysis (TSA). Risk of bias was assessed according to Cochrane methodology.

Results: Some 22 RCTs with 2159 participants were eligible for meta-analysis. Compared with the control group, immunonutrition reduced overall infectious complications (RR 0·58, 95 per cent c.i. 0·48 to 0·70; I2 = 7 per cent; TSA-adjusted 95 per cent c.i. 0·28 to 1·21) and SSI (RR 0·65, 95 per cent c.i. 0·50 to 0·85; I2 = 0 per cent; TSA-adjusted 95 per cent c.i. 0·21 to 2·04). Thirty-day mortality was not altered by immunonutrition (RR 0·69, 0·33 to 1·40; I2 = 0 per cent).

Conclusion: Immunonutrition reduced overall infectious complications, even after controlling for random error, and also reduced SSI. The quality of evidence was moderate, and mortality was not affected by immunonutrition (low quality). Oral immunonutrition merits consideration as a means of reducing overall infectious complications after cancer surgery.

Antecedentes: Entre un 4-22% de los pacientes a los que se realiza una resección quirúrgica de tumores sólidos malignos presentan complicaciones infecciosas. Mejorar el sistema inmunitario del paciente quirúrgico oncológico mediante inmunonutrición puede tener un papel relevante en la reducción de las infecciones postoperatorias. Se realizó un metaanálisis para evaluar los posibles beneficios clínicos de la inmunonutrición en las infecciones postoperatorias y la mortalidad a los 30 días en pacientes sometidos a cirugía oncológica. MÉTODOS: Se realizó una búsqueda en las bases de datos de Pubmed, Embase y Cochrane para identificar los estudios clave. Se consideraron aquellos estudios que incluyeron pacientes con cirugía curativa electiva de un tumor maligno sólido que recibieron inmunonutrición por vía oral antes de la cirugía, así como también los que siguieron con inmunonutrición en el postoperatorio. La variable principal fueron las complicaciones infecciosas generales y las secundarias fueron la infección de la herida quirúrgica y la mortalidad a los 30 días, presentadas como el riesgo relativo (RR) obtenido a partir en un análisis secuencial de experimentos (trial sequential analysis, TSA). El riesgo de sesgo se evaluó según la metodología Cochrane.

Resultados: Para el metaanálisis se identificaron 22 ensayos clínicos con 2.075 participantes. En comparación con el grupo de control, la inmunonutrición redujo las complicaciones infecciosas generales (RR 0,58, i.c. del 95% 0,48-0,70, I2 = 7%, TSA ajustado i.c. del 95% 0,28-1,21) y las infecciones de la herida quirúrgica (RR 0,65, i.c. del 95% 0,50-0,85, I2 = 0%, TSA ajustado, i.c. del 95% 0,21-2,04). No hubo diferencias en la mortalidad a los 30 días (RR 0,69, i.c. del 95% 0,32-1,4, I2 = 0%). CONCLUSIÓN: la inmunonutrición redujo las complicaciones infecciosas generales, incluso después de controlar el error aleatorio. La inmunonutrición también redujo la infección de la herida quirúrgica. La calidad de la evidencia fue moderada y la mortalidad no se vio afectada por la inmunonutrición (baja calidad). La inmunonutrición oral debería ser tenida en cuenta como una forma de reducir las complicaciones infecciosas generales después de la cirugía del cáncer.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA diagram for the review
Figure 2
Figure 2
Cochrane risk‐of‐bias chart
Figure 3
Figure 3
Forest plot comparing overall infectious complications in immunonutrition and control groups A random‐effects model was used for meta‐analysis. Relative risks (RRs) are shown with 95 per cent confidence intervals.
Figure 4
Figure 4
Forest plot comparing surgical‐site infection in immunonutrition and control groups A random‐effects model was used for meta‐analysis. Relative risks (RRs) are shown with 95 per cent confidence intervals. SSI, surgical‐site infection.
Figure 5
Figure 5
Forest plot comparing 30‐day mortality in immunonutrition and control groups A random‐effects model was used for meta‐analysis. Relative risks (RRs) are shown with 95 per cent confidence intervals.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kucur C, Durmus K, Uysal IO, Old M, Agrawal A, Arshad H et al Management of complications and compromised free flaps following major head and neck surgery. Eur Arch Otorhinolaryngol 2016; 273: 209–213. - PubMed
    1. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long‐term survival in patients undergoing curative surgery for colorectal cancer: a study of 12 075 patients. Ann Surg 2015; 261: 497–505. - PubMed
    1. Kaczmarek K, Leminski A, Bancarz A, Zakrzewska A, Slojewski M. Post‐operative infections among patients undergoing radical cystectomy at a tertiary center. Surg Infect (Larchmt) 2018; 19: 451–458. - PubMed
    1. El‐Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg 2007; 245: 665–671. - PMC - PubMed
    1. Grimble RF. Nutritional modulation of immune function. Proc Nutr Soc 2001; 60: 389–397. - PubMed

MeSH terms