Andolfi Marco, Tiberi Michela, Salati Michele, Taus Marina, Campelli Nadia, Xiumè Francesco, Roncon Alberto, Guiducci Gian Marco, Nanto Anna Chiara, Cola Claudia, Angeli Temperoni Loris, Refai Majed
Thoracic Surgery Unit, AOU of Marche, 60126 Ancona, Italy.
Dietetic and Clinical Nutrition Unit, AOU of Marche, 60126 Ancona, Italy.
J Clin Med. 2025 Jun 13;14(12):4226. doi: 10.3390/jcm14124226.
The positive effects of oral nutritional supplements (ONS) on postoperative outcomes have been well recognized in several previous studies. However, to date, little data has been available with respect to determining the best immune modulating supplement to use and what its impact might be in thoracic surgery. The aim of this study was to evaluate the role of preoperative immune-nutritional supplement intake as predictor of postoperative cardiopulmonary complications (CPCs) in patients undergoing uniportal video-assisted thoracoscopic (uVATS) lung resection. This is a retrospective, observational study enrolling consecutive patients who underwent uVATS lung resections for cancer from January 2022 to December 2024 in the context of the Enhanced Pathway of Care (EPC) Program. All patients were evaluated by a nutritionist and dietetics team during the preoperative phase. The nutritional protocol consisted of 250 mL ONS rich in arginine, omega-3-fatty acids, and nucleotides to be taken twice a day for 5-7 days before surgery. Four hundred ninety-one patients were enrolled: 277 patients underwent anatomic lung resection and 214 underwent wedge resection (WR). Utilizing the univariate analysis, we found that in patients undergoing anatomic lung resection, not-ONS-intake, high Body Mass Index (BMI), and arrythmia were correlated with a higher CPCs rate compared to the patients without nutritional supplementation (7.2% ONS vs. 15% not-ONS, = 0.04; BMI 28.4 kg/m vs. BMI 26.4 kg/m, = 0.03; 31.2% arrythmia vs. 9.4% no-arrythmia, < 0.01). These correlations, except for BMI, were confirmed after stepwise logistic regression. Alternately, in patients undergoing WR, hypertension and low-FEV1% were associated with a higher CPCs rate (5.1% hypertension vs. 0.4% no-hypertension, = 0.02; FEV1% 79.7% vs. 95%, = 0.01). Our results demonstrated that preoperative ONS after uVATS anatomic lung resection, in the context of an EPC program, influences the postoperative period, reducing the CPCs rate.
口服营养补充剂（ONS）对术后结局的积极影响在之前的多项研究中已得到充分认可。然而，迄今为止，关于确定最佳免疫调节补充剂及其在胸外科手术中的影响的数据仍然很少。本研究的目的是评估术前摄入免疫营养补充剂作为接受单孔电视辅助胸腔镜（uVATS）肺切除术患者术后心肺并发症（CPC）预测指标的作用。这是一项回顾性观察研究，纳入了2022年1月至2024年12月期间在强化护理路径（EPC）项目背景下因癌症接受uVATS肺切除术的连续患者。所有患者在术前阶段均由营养学家和饮食团队进行评估。营养方案包括每天服用两次250毫升富含精氨酸、ω-3脂肪酸和核苷酸的ONS，术前服用5 - 7天。共纳入491例患者：277例患者接受了解剖性肺切除术，214例接受了楔形切除术（WR）。通过单因素分析，我们发现，在接受解剖性肺切除术的患者中，未摄入ONS、高体重指数（BMI）和心律失常与较高的CPC发生率相关，与未进行营养补充的患者相比（摄入ONS组为7.2%，未摄入ONS组为15%，P = 0.04；BMI为28.4 kg/m² 与BMI为26.4 kg/m²，P = 0.03；心律失常组为31.2%，无心律失常组为9.4%，P < 0.01）。除BMI外，这些相关性在逐步逻辑回归后得到证实。相比之下，在接受WR的患者中，高血压和低第一秒用力呼气容积百分比（FEV1%）与较高的CPC发生率相关（高血压组为5.1%，无高血压组为0.4%，P = 0.02；FEV1%为79.7%与95%，P = 0.01）。我们的结果表明，在EPC项目背景下，uVATS解剖性肺切除术后术前摄入ONS会影响术后恢复，降低CPC发生率。
