The use of preoperative enteral immunonutrition in patients undergoing elective colorectal cancer surgery: A systematic review and meta-analysis

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-03-28 DOI:10.1111/codi.70061

Tyler McKechnie, Tania Kazi, Ghazal Jessani, Victoria Shi, Niv Sne, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu

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Abstract

Aim

The present systematic review and meta-analysis aims to compare adult patients receiving enteral immunonutrition prior to elective colorectal surgery with those receiving conventional preoperative nutrition.

Methods

MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from database inception to March 2024. Articles were included if they were randomized controlled trials or cohort studies evaluating adult patients undergoing elective colorectal surgery comparing preoperative enteral immunonutrition with conventional preoperative nutrition protocols. Main outcomes of interest included surgical site infection, anastomotic leak, overall postoperative morbidity and postoperative length of stay. An inverse variance random effects meta-analysis was performed. Risk of bias was assessed with Cochrane risk of bias assessment tools. The GRADE approach was conducted to assess quality of evidence.

Results

After reviewing 2508 relevant citations, 10 studies met inclusion criteria. Overall, 1521 patients (mean age 64.9 ± 10.0 years, 49.4% women) received preoperative immunonutrition and 1816 patients (mean age 64.1 ± 11.0 years, 52.1% women) received conventional preoperative nutrition. Across seven studies, there was a non-significant 30% relative risk reduction of surgical site infection (risk ratio 0.70, 95% CI 0.44–1.11, P = 0.13, I² = 33%) and a non-significant 44% relative risk reduction of anastomotic leak (risk ratio 0.56, 95% CI 0.28–1.10, P = 0.09, I² = 0%) in the immunonutrition group. Across eight studies, postoperative length of stay was 0.48 days shorter in the immunonutrition group (mean difference −0.48, 95% CI −0.84 to −0.12, P = 0.01, I² = 53%). GRADE certainty of evidence was low or very low for all outcomes.

Conclusion

While point estimates suggest a likely benefit associated with preoperative enteral immunonutrition, wide corresponding 95% CIs suggest uncertainty remains. Further prospective study is warranted.

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目的本系统综述和荟萃分析旨在比较在择期结直肠手术前接受肠道免疫营养的成年患者与接受常规术前营养的患者。方法检索从数据库开始到 2024 年 3 月的 MEDLINE、Embase 和 Cochrane 对照试验中央登记册。对接受择期结直肠手术的成年患者进行评估，比较术前肠内免疫营养与常规术前营养方案的随机对照试验或队列研究的文章均被纳入。主要研究结果包括手术部位感染、吻合口漏、术后总发病率和术后住院时间。进行了反方差随机效应荟萃分析。采用 Cochrane 偏倚风险评估工具对偏倚风险进行评估。采用 GRADE 方法评估证据质量。结果在查阅了 2508 篇相关引文后，有 10 项研究符合纳入标准。总体而言，1521 名患者（平均年龄为 64.9 ± 10.0 岁，49.4% 为女性）接受了术前免疫营养，1816 名患者（平均年龄为 64.1 ± 11.0 岁，52.1% 为女性）接受了常规术前营养。在七项研究中，免疫营养组的手术部位感染相对风险降低了 30%（风险比 0.70，95% CI 0.44-1.11，P = 0.13，I2 = 33%），吻合口漏相对风险降低了 44%（风险比 0.56，95% CI 0.28-1.10，P = 0.09，I2 = 0%），但不显著。在八项研究中，免疫营养组的术后住院时间缩短了0.48天（平均差异-0.48，95% CI -0.84至-0.12，P = 0.01，I2 = 53%）。所有结果的 GRADE 证据确定性都较低或很低。结论虽然点估计值表明术前肠内免疫营养可能带来益处，但相应的 95% CI 较宽表明仍存在不确定性。有必要进一步开展前瞻性研究。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.