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Value of immunonutrition in patients undergoing pancreatic resection: a trial sequential meta-analysis.

Claudio Ricci, Francesco Serbassi, Laura Alberici, Carlo Ingaldi, Leonardo H Eusebi, Emilio De Raffele, Loris Pironi, Anna S Sasdelli, Cristina Mosconi, Valentina Vicennati, Riccardo Casadei

Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association 2023;25(10):1151-1160

PMID: 37328364

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

The benefits of immunonutrition (IM) in patients who underwent pancreatic surgery are unclear.

METHODS

A meta-analysis of randomized clinical trials (RCTs) comparing IM with standard nutrition (SN) in pancreatic surgery was carried out. A random-effects trial sequential meta-analysis was made, reporting Risk Ratio (RR), mean difference (MD), and required information size (RIS). If RIS was reached, false negative (type II error) and positive results (type I error) could be excluded. The endpoints were morbidity, mortality, infectious complication, postoperative pancreatic fistula (POPF) rates, and length of stay (LOS).

RESULTS

The meta-analysis includes 6 RCTs and 477 patients. Morbidity (RR 0.77; 0.26 to 2.25), mortality (RR 0.90; 0.76 to 1.07), and POPF rates were similar. The RISs were 17,316, 7,417, and 464,006, suggesting a type II error. Infectious complications were lower in the IM group, with a RR of 0.54 (0.36-0.79; 95 CI). The LOS was shorter in IM (MD -0.3 days; -0.6 to -0.1). For both, the RISs were reached, excluding type I error.

CONCLUSION

The IM can reduce infectious complications and LOS The small differences in mortality, morbidity, and POPF make it impossible to exclude type II error due to large RISs.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

Address: Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy; Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy. Electronic address: [email protected].; Grad Student in Biology of the Health Faculty, Alma Mater Studiorum, University of Bologna, Italy.; Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy.; Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy; Division of Gastroenterology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy.; Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy; Clinical Nutrition and Metabolism Unit - Centre for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy.; Division of Interventional Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy.; Division of Endocrinology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy; Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy.; Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Italy; Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy.
DOI: 10.1016/j.hpb.2023.03.014

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MeSH Terms: Humans, Immunonutrition Diet, Pancreas, Pancreatectomy, Postoperative Complications, Pancreatic Fistula, Length of Stay
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