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Meta-Analysis
. 2020 Sep 12;12(9):2798.
doi: 10.3390/nu12092798.

Immunonutrition in Patients with Pancreatic Cancer Undergoing Surgical Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Fu-An Yang  1 , Yang-Ching Chen  2   3 , Cheng Tiong  4   5
Affiliations
Meta-Analysis

Immunonutrition in Patients with Pancreatic Cancer Undergoing Surgical Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Fu-An Yang et al. Nutrients. .

Abstract

Immunonutrition is administered to improve the outcome of patients with pancreatic cancer undergoing surgery. However, its effect and mechanism of action remain unclear. Therefore, we conducted this systematic review and meta-analysis to assess its effects on postoperative outcome and the immune system. Randomized controlled trials (RCTs) were identified and data extracted by two reviewers independently from electronic databases from their inception to 31 October 2019. The result was expressed as the risk ratio (RR) for categorical variables and mean difference (MD) for continuous variables with 95% confidence intervals (CIs). Six RCTs published from 1999 and 2016, with a total of 368 patients, were included. The results revealed that immunonutrition significantly decreased the rate of infectious complications (RR = 0.47, 95% CI (0.23, 0.94), p = 0.03) and the length of hospital stay (MD = -1.90, 95% CI (-3.78, -0.02), p = 0.05) by modulating the immune system, especially in preoperative group in subgroup analysis. We therefore recommend that patients with pancreatic cancer undergoing surgery could take the advantage of immunonutrition, especially in the preoperative period.

Keywords: immunonutrition; meta-analysis; pancreatic cancer; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart showing the details for article inclusion and exclusion.
Figure 2
Figure 2
Assessment of risk of bias. (A) Risk of bias graph. (B) Risk of bias summary.
Figure 3
Figure 3
Forest plot of pooled data on postoperative total complications.
Figure 4
Figure 4
Forest plot of pooled data on postoperative infectious complications.
Figure 5
Figure 5
Forest plot of pooled data on postoperative infectious complications—Wound infection.
Figure 6
Figure 6
Forest plot of pooled data on postoperative non-infectious complications.
Figure 7
Figure 7
Forest plot of pooled data on postoperative non-infectious complications—Delayed gastric emptying.
Figure 8
Figure 8
Forest plot of pooled data on postoperative non-infectious complications—Fistula Development.
Figure 9
Figure 9
Forest plot of pooled data on postoperative mortality.
Figure 10
Figure 10
Forest plot of pooled data on length of stay.
Figure 11
Figure 11
Forest plot of pooled data on CD4+ level on postoperative day 3.
Figure 12
Figure 12
Forest plot of pooled data on CD4+ level on postoperative day 7.
Figure 13
Figure 13
Forest plot of pooled data on CD8+ level on postoperative day 3.
Figure 14
Figure 14
Forest plot of pooled data on CD8+ level on postoperative day 7.
See this image and copyright information in PMC

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