Table 1 Characteristics of the Included studies
Study | Characteristics of enrolled patients | Immune Nutrition Components | Method of Administration | Outcomes | Main results | |||
|---|---|---|---|---|---|---|---|---|
| Â | No. (patients/controls) | Age | BMI | Tumor type and stage (No.) | Â | Â | Â | Â |
Sungho Jo, 2006 | 32/28 | 56.8 ± 9.4 1 | NA | Tumors of the pancreas, bile duct, ampulla, and duodenum | Glutamine | Parenteral nutrition. The Gln group received 10ml/kg/day of Glamin (containing 0.2 g Gln) for 7 days, starting from 2nd day before to 5th day after the surgery. | LOS, mortality, CRP, POPF, DGE | No significant beneficial effect of Gln supplementation with a low-dose parenteral regimen was demonstrated on the surgical outcome after a PD for periampullary tumors. |
Daisuke Suzuki, 2010 | 10/10 | 62 ± 4 2 | NA | Tumors of the pancreas, bile duct and ampulla, TNM I/II (4/4) | Arginine, ω–3 fatty acids, and RNA | Oral supplementation. A perioperative group, oral supplementation for 5 days (1,000 kcal/day) before operative resection with a formula enriched with arginine, omega-3 fatty acids, and RNA. | Infectious complications, noninfectious complications, mortality, SIRS, IL-6, POPF | In the perioperative group, the rate of infectious complications was significantly reduced compared with that in the other groups. |
Hirofumi Shirakawa, 2012 | 18/13 | 62.6 ± 8.5 1 | 21.9 ± 2.1 1 | No. of PIDC/BDC/others (4/5/9) | Arginine, ω–3 fatty acids, and RNA | Oral supplementation. The patients were instructed to consume 3 packs/day (750 mL, 9.6 g of arginine, 2.49 g of omega-3 fatty acids, and 0.96 g of RNA) of Impact Japanese version in addition to their normal diets over a 5-day period immediately before surgery. | LOS, mortality, CRP, SIRS, POPF, DGE | Preoperative ingestion of Impact appeared effective in preventing wound infections and reducing surgical stress responses. |
Numan Hamza, 2014 | 17/20 | 63(58–69) 3 | 27.0 (25.3–28.7) 3 | Pancreatic/Ampullary cancer/Duodenal cancer/Ductal atypia (10/4/1/2) | Arginine, ω–3 fatty acids, and RNA | Oral supplementation. Patients were asked to consume 3 cartons (200 mL per carton) of either feed per day for 14 days before surgery (IMPACT feed contains arginine 1.9 g/100 mL, mRNA 0.255 g/100 mL, Omega-3-fatty acids 0.5 g/100 mL). | IL-6 | Administering EIMN rather than SEN perioperatively is associated with a favorable modulation of the inflammatory response. |
Toshiaki Aida, 2014 | 25/25 | 66.4 ± 1.5 2 | 21.5 ± 0.5 2 | Tumors of pancreatic/bile duct/ampullary/0thers (14/4/3/4), TNM 0/I/II/III/IV (2/3/10/5/1) | Arginine, ω–3 fatty acids, and RNA | Oral supplementation. Patients in the IN group received oral supplementation (1,000 kcal/day) containing arginine, u-3 fatty acids, and RNA for 5 days before surgery. | Infectious complications, noninfectious complications, mortality, IL-6, SIRS, POPF, DGE | The IMN group had a lower infectious complication rate and less severe complications compared to the control group. |
S. Silvestri, 2016 | 48/48 | 62.27 ± 11.45 4 | 24.5 ± 3.5 4 | Tumors of pancreatic/ampullary/biliary/others(28/6/8/6) | Arginine, ω–3 fatty acids, and RNA | Oral supplementation. Preoperative IN supplemental liquid diet (Oral Impact, L-arginine 1.8 g, RNA 0.2 g, ommege-3 fatty acids 0.6 g) for at least 5 days before pancreatic surgery. | LOS, infectious complications, mortality, POPF, DGE | Preoperative oral IMN reduces infection risk and hospital stay duration for well-nourished PD patients. |
Josephine Gade, 2016 | 19/16 | 68 (50–81) 5 | 24.3 (18.8–28.3) 5 | Pancreatic cancer/benign pancreatic tumor (24/11) | Arginine, ω–3 fatty acids, and RNA | Oral supplementation. The intervention group received 7 days of preoperative oral IN, Oral Impact Powder as a supplement to their normal diet to reach a total goal of 1.5 g protein/kg. | LOS, infectious complications, mortality | Adding IMN to the diet preoperatively with the goal of achieving 1.5 g protein/kg body weight did not result in significant clinical benefits for patients scheduled for pancreatic surgery |
Ryo Ashida, 2019 | 11/9 | 64 ± 11 2 | 55.9 ± 13.5 2 | Tumors of the pancreas/bile duct/ampulla/others (3/2/3/3) | ω–3 fatty acids | Oral supplementation. Patients in the treatment group received oral supplementation (600 kcal/day) containing EPA for 7 days before surgery, in addition to 1,200 kcal of regular food. | Infectious complications, IL-6, POPF | Preoperative IMN had limited effect on the occurrence of postoperative hypercytokinemia or infectious complications in patients undergoing PD |
Jaroslav Tumas, 2020 | 30/40 | 62.6 ± 10.5 1 | 26.8 ± 5.6 1 | PDAC/others (17/13) | L-arginine and polyunsaturated fats | Oral supplementation. IN group received 5 days of preoperative IN (L-arginine 6.04 g/day and polyunsaturated fat 4 g/day) in addition to the usual preoperative nutritional management. | IL-6, CRP | IMN may be more beneficial for patients with PDAC than those with benign pancreatic diseases or less aggressive tumors, regardless of their nutritional status. |
Xuanji Wang, 2022 | 83/70 | 66 6 | 26.1 6 | PDAC/others (83/125) | Arginine, ω–3 fatty acids, and RNA | Oral supplementation. Patients were given and instructed to take IMPACT for 5 days, 3 times daily, prior to surgery. | Infectious complications, POPF, DGE | Preoperative IMN had no effect on LOS or infections in PDAC patients undergoing PD. However, in non-PDAC patients, it was linked to longer LOS and higher rates of intraabdominal infections |