Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Sforza 35, 20122, Milan, MI, Italy.
Department of Oncologic and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Int J Colorectal Dis. 2020 Jan;35(1):19-27. doi: 10.1007/s00384-019-03438-4. Epub 2019 Nov 21.
The aim of this study is to evaluate whether preoperative immunonutrition can shorten length of stay and improve postoperative outcomes in frail patients who are candidates for major oncologic colorectal surgery.
A single center retrospective analysis of a prospectively collected database of frail patients, who underwent surgery with curative intent for colorectal cancer between January 2014 and December 2017, was performed. From March 2016, frail oncological patients undergoing major surgery were recommended to receive preoperative immunonutrition; their postoperative outcomes were compared to those of patients not treated with any preoperative nutritional support. Propensity score matching in a 1:1 ratio was used to balance patient characteristics.
Overall, 175 patients were included in the study. Of 74 patients receiving immunonutrition, 65 were matched with the group not treated with immunonutrition (n = 101). Baseline characteristics were comparable after matching. Although differences in postoperative length of stay were nonsignificant (p = 0.38), patients who received immunonutrition showed a shorter gastrointestinal (GI) recovery time (3.00 [2.00-4.00] versus 4.00 [2.00-5.00], p = 0.04), a lower rate of situs site infections complications (0.31 [0.10, 0.94], p = 0.04) and less need of antibiotic treatment (0.19 [0.06, 0.64], p = 0.01).
Preoperative immunonutrition was found to reduce both postoperative situs site infections and need of antibiotic treatment during the postoperative course. This study encourages the use of preoperative immune-enhancing nutrition as a part of multimodal prehabilitation programs in the management of frail colorectal cancer patients.
本研究旨在评估术前免疫营养是否可以缩短虚弱患者接受结直肠肿瘤根治性手术的住院时间并改善术后结局。
对 2014 年 1 月至 2017 年 12 月期间因结直肠癌接受手术治疗且身体虚弱的患者进行了一项前瞻性收集数据库的单中心回顾性分析。从 2016 年 3 月开始，建议接受重大手术的虚弱肿瘤患者接受术前免疫营养治疗；并将他们的术后结局与未接受任何术前营养支持的患者进行比较。采用 1:1 比例的倾向评分匹配来平衡患者特征。
共有 175 例患者纳入本研究。在接受免疫营养治疗的 74 例患者中，有 65 例与未接受免疫营养治疗的患者（n=101）进行了匹配。匹配后两组的基线特征具有可比性。尽管术后住院时间的差异无统计学意义（p=0.38），但接受免疫营养治疗的患者胃肠道（GI）恢复时间更短（3.00[2.00-4.00] 与 4.00[2.00-5.00]，p=0.04），发生手术部位感染并发症的比率更低（0.31[0.10, 0.94]，p=0.04），抗生素治疗的需求更少（0.19[0.06, 0.64]，p=0.01）。
术前免疫营养可降低术后手术部位感染和抗生素治疗的需求。本研究鼓励将术前免疫增强营养作为虚弱结直肠癌患者多模式康复计划的一部分。
