Perioperative or combined preoperative and postoperative standard nutrition therapy for patients with head and neck or gastrointestinal cancer: A systematic review and meta-analysis

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-04-04 DOI:10.1016/j.clnesp.2025.03.170

Masano Sagawa , Ryota Matsui , Akihiko Sano , Makoto Sakai , Shinichiro Hiraoka , Isao Tabei , Takayuki Imai , Hideo Matsumoto , Seiji Onogawa , Norihiro Sonoi , Shigeyuki Nagata , Ryo Ogawa , Shigeki Wakiyama , Yasuhiro Miyazaki , Koshi Kumagai , Rie Tsutsumi , Takehiro Okabayashi , Yu Uneno , Naoki Higashibeppu , Joji Kotani

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引用次数: 0

Abstract

Background & aims

Since malnutrition is a risk factor for postoperative complications, preoperative nutritional therapy is recommended to reduce postoperative complications. Few meta-analyses conducted exclusively in cancer patients have shown that perioperative standard nutritional therapy reduces postoperative complications. This study examined whether preoperative or combined preoperative and postoperative standard nutritional therapy reduced postoperative complications in patients with head and neck or gastrointestinal (GI) cancer.

Methods

We conducted randomized controlled trials in 1979–2021. Patients who received standard nutritional interventions were classified as the intervention group and those who did not receive any nutritional intervention as controls. The primary outcome was the total number of postoperative complications and infectious complications.

Results

In total, 19 studies were included (n = 2047). Of 19 studies, 5 were for upper GI cancer, 8 were for lower GI cancer, 5 were for upper and lower GI cancers, and 1 was for head and neck cancer. Total postoperative and infectious complications were reported in 15 (n = 1762) and 9 (n = 905) studies. The meta-analysis showed that standard nutritional interventions may reduce the total complication rates (RR: 0.78, 95 % CI: 0.65–0.94) and infectious complications (RR: 0.67, 95 % CI: 0.51–0.87). There were no significant differences in subgroup analyses, according to the nutritional therapy timing and nutritional status. The risk of bias was high for random sequence generation, allocation concealment, and participants' and data analysts’ blinding. COE for total postoperative and infectious complications was weak and inconsistent due to the high risk of bias and substantial heterogeneity.

Conclusion

Although the present study was inconclusive due to the small number of studies in head and neck cancer, preoperative or combined preoperative and postoperative standard nutrition therapy in patients with GI cancer may significantly reduce the incidence of postoperative complications. Further studies are needed to confirm these findings and to reduce the risk of bias.

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背景和目的：由于营养不良是导致术后并发症的一个风险因素，因此建议进行术前营养治疗以减少术后并发症。很少有专门针对癌症患者进行的荟萃分析表明，围手术期标准营养疗法可减少术后并发症。本研究探讨了术前或术前术后联合标准营养疗法是否能减少头颈部或胃肠道（GI）癌症患者的术后并发症：我们在 1979-2021 年间进行了随机对照试验。接受标准营养干预的患者被列为干预组，未接受任何营养干预的患者被列为对照组。主要结果是术后并发症和感染性并发症的总数：结果：共纳入 19 项研究（n = 2 047）。在 19 项研究中，5 项针对上消化道癌症，8 项针对下消化道癌症，5 项针对上下消化道癌症，1 项针对头颈部癌症。15项（n=1,762）和9项（n=905）研究报告了术后并发症和感染性并发症的总数。荟萃分析表明，标准营养干预可降低总并发症发生率（RR：0.78，95% CI：0.65-0.94）和感染性并发症发生率（RR：0.67，95% CI：0.51-0.87）。根据营养治疗时间和营养状况进行的亚组分析无明显差异。随机序列生成、分配隐藏、参与者和数据分析师的盲法存在较高的偏倚风险。由于存在高偏倚风险和大量异质性，术后总并发症和感染性并发症的COE较弱且不一致：尽管由于头颈部癌症的研究较少，本研究尚无定论，但对消化道癌症患者进行术前或联合术前术后标准营养治疗可显著降低术后并发症的发生率。为证实这些研究结果并降低偏倚风险，还需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.