Haonan Guan1, Sanwei Chen1, Qiang Huang2. 1. Department of General Surgery, Hepatobiliary and Pancreatic Laboratory of Anhui Province, Affiliated Provincial Hospital of Anhui Medical University, Hefei, China. 2. Department of General Surgery, Hepatobiliary and Pancreatic Laboratory of Anhui Province, Affiliated Provincial Hospital of Anhui Medical University, Hefei, China, ahslyy_hq@163.com.
Abstract
BACKGROUND: The effect of enteral immunonutrition (EIN) in patients undergoing pancreaticoduodenectomy (PD) is still doubtful. This meta-analysis aimed to assess the impact of EIN on postoperative clinical outcomes for patients undergoing PD. METHODS: A literature search was carried out to identify all of the randomized controlled trials (RCTs) concerning the use of EIN for PD. Data collection ended on April 1, 2018. Pooled risk ratios (RRs) and the mean difference (MD) with a 95% CI were calculated using fixed effects or random effects models. The analyses were performed with RevMan 5.3.5. RESULTS: Four RCTs with a total of 299 patients were included. Immunonutrition reduced the incidence of postoperative infectious complications (RR 0.58, 95% CI 0.37-0.92; p = 0.02) and shortened the length of hospital stay (MD -1.79, 95% CI -3.40 to 0.18; p = 0.03). Conversely, there were no significant differences in the incidence of overall postoperative complications (RR 0.81, 95% CI 0.62-1.05; p = 0.11), non-infectious complications (RR 0.94, 95% CI 0.69-1.28; p = 0.70) and postoperative mortality (RR 2.43, 95% CI 0.37-16.10; p = 0.36). CONCLUSIONS: EIN reduced postoperative infectious complications and shortened the length of the hospital stay; immunonutrition should be encouraged in patients undergoing PD.
BACKGROUND: The effect of enteral immunonutrition (EIN) in patients undergoing pancreaticoduodenectomy (PD) is still doubtful. This meta-analysis aimed to assess the impact of EIN on postoperative clinical outcomes for patients undergoing PD. METHODS: A literature search was carried out to identify all of the randomized controlled trials (RCTs) concerning the use of EIN for PD. Data collection ended on April 1, 2018. Pooled risk ratios (RRs) and the mean difference (MD) with a 95% CI were calculated using fixed effects or random effects models. The analyses were performed with RevMan 5.3.5. RESULTS: Four RCTs with a total of 299 patients were included. Immunonutrition reduced the incidence of postoperative infectious complications (RR 0.58, 95% CI 0.37-0.92; p = 0.02) and shortened the length of hospital stay (MD -1.79, 95% CI -3.40 to 0.18; p = 0.03). Conversely, there were no significant differences in the incidence of overall postoperative complications (RR 0.81, 95% CI 0.62-1.05; p = 0.11), non-infectious complications (RR 0.94, 95% CI 0.69-1.28; p = 0.70) and postoperative mortality (RR 2.43, 95% CI 0.37-16.10; p = 0.36). CONCLUSIONS: EIN reduced postoperative infectious complications and shortened the length of the hospital stay; immunonutrition should be encouraged in patients undergoing PD.