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Meta-Analysis
. 2023 Apr 17;23(1):351.
doi: 10.1186/s12885-023-10820-7.

The Effect of immunonutrition in patients undergoing pancreaticoduodenectomy: a systematic review and meta-analysis

Yinyin Fan  1   2 , Nianxing Li  2 , Jing Zhang  2 , Qiaomei Fu  2 , Yudong Qiu  2 , Yan Chen  3   4   5
Affiliations
Meta-Analysis

The Effect of immunonutrition in patients undergoing pancreaticoduodenectomy: a systematic review and meta-analysis

Yinyin Fan et al. BMC Cancer. .

Abstract

Background: Pancreaticoduodenectomy (PD) is a complex and traumatic abdominal surgery with a high risk of postoperative complications. Nutritional support, including immunonutrition (IMN) with added glutamine, arginine, and ω-3 polyunsaturated fatty acids, can improve patients' prognosis by regulating postoperative inflammatory response. However, the effects of IMN on PD patients' outcomes require further investigation.

Methods: PMC, EMbase, web of science databases were used to search literatures related to IMN and PD. Data such as length of hospital stay, infectious complications, non-infectious complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), mortality, systemic inflammatory response syndrome (SIRS) duration, IL-6, and C-reactive protein (CRP) were extracted, and meta-analyses were performed on these data to study their pooled results, heterogeneity, and publication bias.

Results: This meta-analysis involved 10 studies and a total of 572 patients. The results showed that the use of IMN significantly reduced the length of hospital stay for PD patients (MD = -2.31; 95% CI = -4.43, -0.18; P = 0.03) with low heterogeneity. Additionally, the incidence of infectious complications was significantly reduced (MD = 0.42; 95% CI = 0.18, 1.00, P = 0.05), with low heterogeneity after excluding one study. However, there was no significant impact on non-infectious complications, the incidence of POPF and DGE, mortality rates, duration of SIRS, levels of IL-6 and CRP.

Conclusion: The use of IMN has been shown to significantly shorten hospital stays and decrease the frequency of infectious complications in PD patients. Early implementation of IMN is recommended for those undergoing PD. However, further research is needed to fully assess the impact of IMN on PD patients through larger and higher-quality studies.

Keywords: Immunonutrition; Infectious complications; Length of hospital stay; Pancreaticoduodenectomy; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of the selection process
Fig. 2
Fig. 2
Risk of bias assessment of included studies
Fig. 3
Fig. 3
Meta-analysis of the effect of IMN on hospitalization days Forest plot of length of hospital stay. The random-effects model was used. The square size of individual studies represented the weight of the study. Vertical lines represent 95% CI of the pooled estimate. The diamond represents the overall summary estimate, with the 95% CI given by its width
Fig. 4
Fig. 4
Meta-analysis of the effect of IMN on the incidence of infectious complications Forest plot of infectious complications. The random-effects model was used. The square size of individual studies represented the weight of the study. Vertical lines represent 95% CI of the pooled estimate. The diamond represents the overall summary estimate, with the 95% CI given by its width
Fig. 5
Fig. 5
Meta-analysis of the effect of IMN on the incidence of non-infectious complications The forest plot displays the incidence of non-infectious complications, with the fixed-effects model used for the analysis. The plot provides a visual representation of the effect sizes and confidence intervals for each study included in the analysis, allowing for a comparison of the results and assessment of the overall effect of IMN on non-infectious complications following surgery
Fig. 6
Fig. 6
Meta-analysis of the effect of IMN on the incidence of POPF and DGE The forest plot shows the incidence of postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE) as separate panels (A and B), with the fixed-effects model employed to analyze the data
Fig. 7
Fig. 7
Meta-analysis of the effect of IMN on postoperative mortality Forest plot of postoperative mortality, with the random-effects model used for the analysis. The random-effects model accounts for the potential heterogeneity among the studies and provides a more conservative estimate of the overall effect size
Fig. 8
Fig. 8
Meta-analysis of IMN on postoperative SIRS duration Forest plot of postoperative SIRS duration, with the random-effects model used for the analysis
Fig. 9
Fig. 9
Meta-analysis of the effect of IMN on IL-6 and CRP Forest plot depicting the levels of IL-6 and CRP analyzed separately (A and B) using a random-effects model
See this image and copyright information in PMC

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