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. 2024 May 29;16(11):1682.
doi: 10.3390/nu16111682.

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

Susy Dal Bello  1 , Stefano Mancin  2 , Sara Morales Palomares  3 , Diego Lopane  2 , Luca Di Gianfrancesco  1 , Chiara Soligo  1 , Tommaso Tarantino  1 , Paolo Perdonò  1 , Rodolfo Hurle  2 , Bruno Bernardini  2 , Federico Piccioni  2 , Manuela Pastore  2 , Alvarez Pellegrinelli  4 , Angelo Porreca  1 , Beatrice Mazzoleni  5
Affiliations

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

Susy Dal Bello et al. Nutrients. .

Abstract

Background/aim: Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy.

Methods: A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence.

Results: Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73-0.93; p = 0.0029) and decrease postoperative complications (-36.7%; p = 0.008) and readmission rates (-15.38%; p = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (-1 day; p < 0.01), a reduction in the length of hospital stay (-1.75 days; p = 0.01), an improvement in handgrip strength (+6.8%, p < 0.001), an increase in bone mass (+0.3 kg, p = 0.04), and a better BMI value (+2.3%, p = 0.001).

Conclusions: Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results.

Keywords: cystectomy; nutrition; prehabilitation; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA Flow Diagram. NP = nutritional prehabilitation.
Figure 2
Figure 2
Effect of ONS and NC before radical cystectomy. Legend: POC = post-operative complication; ReR = readmission rate; LOS = length of stay; Aggregated data with statistical significance (p ≤ 0.05) are presented.
Figure 3
Figure 3
Effects of immunonutrition prior to radical cystectomy. Legend: ONS = oral nutritional supplement; NC = nutritional counselling; LOS = length of stay; BMI = body mass index. Aggregated data with statistical significance (p ≤ 0.05) are presented.
See this image and copyright information in PMC

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