Lyon Timothy D, Turner I I Robert M, McBride Dawn, Wang Li, Gingrich Jeffrey R, Hrebinko Ronald L, Jacobs Bruce L, Davies Benjamin J, Tarin Tatum V
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Can J Urol. 2017 Aug;24(4):8895-8901.
To investigate the use of a high-arginine immunonutrient supplement prior to radical cystectomy for bladder cancer.
We recruited 40 patients to consume a total of four high-arginine immunonutrient shakes per day for 5 days prior to radical cystectomy. The primary outcome measures were safety, tolerability and adherence to the supplementation regimen. Ninety-day postoperative outcomes were also compared between supplemented patients and a cohort of 104 prospectively identified non-supplemented radical cystectomy patients. Multivariable logistic regression models were used to compare overall complications, infectious complications, and readmission rates between groups.
There were no serious adverse events during supplementation. Four patients (10%) stopped supplementation due to nausea (n = 2) and bloating (n = 2). Thirty-three patients (83%) consumed all prescribed shakes. Immunonutrient supplementation was not significantly associated with overall complications (adjusted odds ratio [OR] 1.08; 95% confidence interval [CI] 0.50-2.33), infectious complications (OR 1.23; 95% CI 0.49-3.07), or readmissions (OR 1.48; 95% CI 0.62-3.51) on multivariable analyses.
Preoperative supplementation with a high-arginine immunonutrient shake was safe and well tolerated prior to radical cystectomy. Contrary to prior reports, immunonutrient supplementation was not associated with lower postoperative infectious complications in this cohort, perhaps owing to the 5 day supplementation period. Further study is needed to identify the optimal immunonutrient supplement regimen for radical cystectomy patients.
探讨高精氨酸免疫营养补充剂在膀胱癌根治性膀胱切除术之前的应用。
我们招募了40名患者，在根治性膀胱切除术之前5天，每天总共饮用4份高精氨酸免疫营养奶昔。主要结局指标为安全性、耐受性和对补充方案的依从性。还比较了补充营养的患者与104名前瞻性确定的未补充营养的根治性膀胱切除术患者队列的术后90天结局。使用多变量逻辑回归模型比较两组之间的总体并发症、感染性并发症和再入院率。
补充营养期间未发生严重不良事件。4名患者（10%）因恶心（n = 2）和腹胀（n = 2）停止补充营养。33名患者（83%）饮用了所有规定的奶昔。多变量分析显示，免疫营养补充与总体并发症（校正比值比[OR] 1.08；95%置信区间[CI] 0.50 - 2.33）、感染性并发症（OR 1.23；95% CI 0.49 - 3.07）或再入院（OR 1.48；95% CI 0.62 - 3.51）均无显著相关性。
在根治性膀胱切除术之前，术前补充高精氨酸免疫营养奶昔是安全且耐受性良好的。与先前的报道相反，在该队列中，免疫营养补充与较低的术后感染性并发症无关，这可能归因于5天的补充期。需要进一步研究以确定根治性膀胱切除术患者的最佳免疫营养补充方案。
