Second Department of General and Gastroenterological Surgery, Medical University of Bialystok, M. Sklodowskiej-Curie Street 24a, 15-276 Bialystok, Poland.
Nutrients. 2023 Oct 11;15(20):4328. doi: 10.3390/nu15204328.
The aim of this study was to determine the influence of our own model of immunonutrition on phase angle and postoperative complications. Our goal was to establish modern prehabilitation procedures for patients operated on for pancreatic cancer.
Patients with pancreatic cancer who qualified for surgical treatment were divided into two groups. Group I (20 patients; 12 with pancreatic head cancer, 8 with pancreatic tail/body cancer) was given immunonutrition (Impact Oral 3× a day, 237 mL, for 5 days before surgery, and after surgery for an average of 3.5 days). Group II (20 patients; 12 with pancreatic head cancer, 8 with pancreatic tail/body cancer) did not receive immunonutrition. Body weight, body mass index and phase angle were assessed on admission to the hospital, after preoperative immunonutrition, on the third and eighth postoperative days. C-reactive protein and Interleukin-1 α were measured on admission to the hospital, after preoperative immunonutrition, on the eighth postoperative day. Postsurgical complications were assessed via Clavien-Dindo classification.
On admission to the hospital, the phase angle was 5.0° (4.70-5.85) in Group I and 5.1° (5.00-6.25) in Group II. After 5 days of using preoperative immunonutrition, it increased statistically significantly ( < 0.02) to 5.35°. In Group I, on the third day after surgery, it decreased statistically significantly ( < 0.001) to 4.65°, and then, increased to 4.85° on the eighth day. In Group II, statistically significant decreases in the phase angle were observed on the third (4.5°; < 0.002) and eighth (4.55°; < 0.008) days after surgery. A statistically significant increase in CRP (86.6 mg/dL; < 0.02) and IL-1α (18.5 pg/mL; < 0.03) levels was observed on the eighth day after surgery in this group. In Group I, a statistically significant negative correlation (R -0.501106; < 0.002) of the phase angle after 5 days of preoperative immunonutrition with postoperative complications was observed.
This study used our own model of immunonutrition in patients undergoing surgery for pancreatic cancer. The applied model of perioperative IN improved the postoperative course of patients operated on due to pancreatic cancer. Fewer complications were observed in patients in the group receiving IN. Also, the PA value increased after the 5-day preoperative IN, and the use of perioperative IN improved the PA value on the eighth postoperative day compared to the group that did not receive IN. On this day, an increase in inflammatory parameters was also observed in the group that did not receive IN. In addition, PA correlated negatively with complications. The PA can be a useful tool to assess the effectiveness of the applied IN, and thus, to predict the occurrence of postoperative complications. Therefore, there is a further need for studies on larger groups of patients.
本研究旨在确定我们自身的免疫营养模型对相位角和术后并发症的影响。我们的目标是为接受胰腺癌手术的患者建立现代的术前康复程序。
符合手术治疗条件的胰腺癌患者被分为两组。第 I 组（20 例；12 例胰头癌，8 例胰尾/体癌）接受免疫营养（Impact Oral，每天 3 次，每次 237 mL，术前 5 天使用，术后平均使用 3.5 天）。第 II 组（20 例；12 例胰头癌，8 例胰尾/体癌）未接受免疫营养。入院时、术前免疫营养后、术后第 3 天和第 8 天评估体重、体重指数和相位角。入院时、术前免疫营养后、术后第 8 天检测 C 反应蛋白和白细胞介素-1α。通过 Clavien-Dindo 分类评估术后并发症。
入院时，第 I 组的相位角为 5.0°（4.70-5.85），第 II 组为 5.1°（5.00-6.25）。使用术前免疫营养 5 天后，相位角显著增加（<0.02）至 5.35°。第 I 组患者术后第 3 天，相位角显著下降（<0.001）至 4.65°，然后在第 8 天增加至 4.85°。第 II 组患者在术后第 3 天（4.5°；<0.002）和第 8 天（4.55°；<0.008）相位角明显下降。该组患者术后第 8 天 CRP（86.6mg/dL；<0.02）和 IL-1α（18.5pg/mL；<0.03）水平显著升高。第 I 组患者术后第 5 天接受术前免疫营养后，相位角与术后并发症呈显著负相关（R=-0.501106；<0.002）。
本研究在接受胰腺癌手术的患者中使用了我们自身的免疫营养模型。应用的围手术期免疫营养模式改善了接受胰腺癌手术患者的术后病程。接受免疫营养的患者并发症较少。此外，与未接受免疫营养的患者相比，接受 5 天术前免疫营养后相位角增加，并且围手术期免疫营养可使第 8 天的相位角增加。在这一天，未接受免疫营养的患者中也观察到炎症参数的增加。此外，PA 与并发症呈负相关。PA 可以作为评估应用 IN 效果的有用工具，从而预测术后并发症的发生。因此，需要进一步对更大的患者群体进行研究。
