Immunonutrition in elective colorectal surgery and early inflammatory response

Personalized nutritional care for immune function recovery in postoperative gastrointestinal surgery patients: An observational study

BACKGROUND

Gastrointestinal (GI) surgery can significantly affect the nutritional status and immune function of patients. This study aimed to investigate the effects of personalized nutritional care on the recovery of immune function in patients who underwent postoperative GI surgery.

AIM

To study examines personalized nutritional care’s impact on immune function recovery, nutritional status, and clinical outcomes after GI surgery.

METHODS

This observational study included 80 patients who underwent GI surgery between 2021 and 2023. Patients received personalized nutritional care based on their individual needs and surgical outcomes. Immune function markers including lymphocyte subsets, immunoglobulins, and cytokines were measured preoperatively and at regular intervals postoperatively. Nutritional status, clinical outcomes, and quality of life were assessed.

RESULTS

Patients receiving personalized nutritional care showed significant improvements in immune function markers compared to baseline. At 4 weeks postoperatively, CD4+ T-cell counts increased by 25% (P < 0.001), while interleukin-6 levels decreased by 40% (P < 0.001). Nutritional status, as measured by prealbumin and transferrin levels, improved by 30% (P < 0.01). Postoperative complications reduced by 35% compared to historical controls. The quality-of-life scores improved by 40% at 3 months postoperatively.

CONCLUSION

Personalized nutritional care enhances immune function recovery, improves nutritional status, and reduces complications in patients undergoing postoperative GI surgery, highlighting its crucial role in optimizing patient outcomes following such procedures.

High glycemic variability serves as an independent risk factor for postoperative infection-related complications in patients undergoing radical surgery for gastric, colon, and rectal cancer

Patients with gastrointestinal surgery have a higher incidence of infection-related complications than the rest of those who undergo clean cut surgery. It can lead to a worse prognosis for patients. This study aimed to assess the association between glycemic variability (GV) and postoperative infection-related complications of gastrointestinal cancer patients. A total of 438 patients were included in this study. Using univariate and multivariate regression analyses, the risk factors for postoperative complications were determined. And nomogram prediction models were constructed through machine learning. The performance of the nomogram was assessed with respect to the calibration curves. Univariate and multivariate regression analysis showed that high GV on post operation day (POD)1 (P < .001), high leukocytes on POD4 (P = .003 < .01) and alcohol consumption (P = .005 < .01) were independent risk factors for postoperative infection-related complications in patients with gastrointestinal cancers. The area under the curve (AUC) showed that these 3 prediction models established through logistic regression (AUC = 0.81), XGBoost (AUC = 0.82) and random forest (AUC = 0.78) all performed well. Our study confirmed that higher GV on POD1 were independent risk factors for postoperative infection-related complications within 30 days of surgery in patients with gastrointestinal cancers. And the nomogram prediction model confirmed its capable for predicting infection-related complications.

Arginine on immune function and post-operative obstructions in colorectal cancer patients: a meta-analysis

BACKGROUND

The aim of this study is to investigate the impact of arginine on immune function and postoperative complications in colorectal cancer (CRC) patients.

METHODS

We conducted a comprehensive search to identify eligible RCTs in various databases, such as PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, China National Knowledge Infrastructure (CNKI), Wanfang, VIP Medicine Information System (VIP), and Chinese Biomedical Database (CBM). This study aimed to examine IgA, IgG, and IgM levels as well as CD4+ and CD8+ counts as well as the CD4+/CD8+ ratio. Anastomotic leaking, length of stay (LOS), and surgical site infection (SSI) were included as secondary outcomes. Stata (StataCorp, version 14.0) was utilized for data analysis. To ensure the results were reliable, we used meta-regression, sensitivity analysis, and publication bias analysis.

RESULTS

A total of 24 publications (including 1883 patients) out of 681 that were retrieved fulfilled the inclusion criteria. The arginine group showed notable improvements in humoral immunity, with gains in IgA (SMD=0.45, 95% CI: 0.30-0.60), IgG (SMD=0.80, 95% CI: 0.64-0.96), and IgM (SMD=0.66, 95% CI: 0.39-0.93). With regards to cellular immunity, the arginine group exhibited a substantial increase in the CD4+ T cell count (SMD = 1.03, 95% CI: 0.67-1.38) compared to the control group. However, the CD4+/CD8+ ratio decreased significantly (SMD=1.37, 95% CI: 0.88-1.86) in the same arginine group, indicating a change in the balance between these two cell types. Additionally, the CD8+ T cell count showed a notable decrease (SMD=-0.70, 95% CI: -1.09 to -0.32) in the arginine group when compared to the control group. Anastomotic leakage was also considerably lower in the arginine group (SMD=-0.05, 95% CI: -0.08 to -0.02), the rate of SSIs was lower (RR = -0.02, 95% CI: -0.05-0), and the length of time patients spent in the hospital was shorter (SMD=-0.15, 95% CI: -0.38 to -0.08).

CONCLUSIONS

After radiation treatment for CRC, arginine improves immune function and decreases the risk of infection problems.

TRIAL REGISTRATION

Registration with PROSPERO for this meta-analysis is number CRD42024520509.

Pre-Operative Immunonutrition Enhances Postoperative Outcomes and Elevates Tumor-Infiltrating Lymphocyte Counts in Colorectal Cancer Patients: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

This study (CRD42023464989) aimed to explore the effects of pre-operation immunonutrition on safety and immune related factors in colorectal cancer patients undergoing surgery.

METHODS

We systematically searched PubMed, Embase, and Wanfang databases to collect all clinical randomized controlled trials of the application of pre-operation immunonutrition for patients with colorectal cancer, published until July 2023. The primary outcomes were safety and immune related factors.

RESULTS

A total of 16 studies were finally included. Preoperative immunonutrition could reduce the postoperative infection rate (risk ratio (RR) = 0.56, 95% confidence interval (CI): 0.36, 0.88; p = .01), and wound infection rate (RR = 0.44, 95% CI: 0.27, 0.70; p < .001) in patients with colorectal cancer. For length of stay (mean difference (MD) = -1.10, 95% CI: -2.70, 0.49; p = .17), it was similar between groups. Meanwhile, patients in the pre-operation immune nutrition group also had significantly increased infiltrative lymphocytes CD16+ (MD = 0.04, 95% CI: 0.02, 0.06; p < .001), and CD56+ (MD = 0.05, 95% CI: 0.03, 0.06; p < .001) cells in the tumor tissues, compared to the control group.

CONCLUSION

Immunonutrition intervention has the potential to reduce postoperative infectious complications and improve tumor infiltrative lymphocytes in patients with colorectal cancer undergoing surgery.

Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II-III Colorectal Cancer

BACKGROUND

The Naples prognostic score (NPS) is a scoring system that reflects a patient's systemic inflammatory and nutritional status. This study aimed to evaluate whether postoperative NPS is effective in assessing the prognosis of stage II-III colorectal cancer (CRC) patients compared with preoperative NPS.

METHODS

Between 2005 and 2012, a total of 164 patients diagnosed with stage II-III CRC, who underwent curative resection followed by adjuvant chemotherapy, were divided into two groups: Group 0-1 (NPS = 0-2) and Group 2 (NPS = 3 or 4). Preoperative NPS was calculated based on the results before surgeries, and postoperative NPS was assessed using the results obtained before adjuvant chemotherapy.

RESULTS

The overall survival of Group 0-1 was higher than that of Group 2 in both pre- and postoperative NPS assessments. According to the ROC curve analysis, the Area Under the Curve (AUC) ratio for postoperative NPS was 0.64, compared with 0.57 for preoperative NPS, 0.52 for the preoperative neutrophil-lymphocyte ratio (p = 0.032), and 0.51 for the preoperative platelet-lymphocyte ratio (p = 0.027).

CONCLUSIONS

Postoperative NPS is effective in predicting the prognosis of stage II-III CRC patients who underwent curative resection followed by adjuvant chemotherapy. The use of NPS could be beneficial in evaluating the prognosis of CRC patients after surgeries.

Effect of Glutamine on Short-term Surgical Outcomes in Rectal Cancer Patients Receiving Neoadjuvant Therapy: A Propensity Score Matching Study

The effect of glutamine on postoperative complications and postoperative recovery in rectal cancer (RC) patients receiving neoadjuvant therapy (NT) is unclear. This study aimed to investigate the effects of intravenous glutamine supplementation on short-term postoperative outcomes in these patients. This retrospective study included patients with RC who received NT and underwent radical surgery between January 2013 and July 2022 and were either administered glutamine (glutamine group) or not administered glutamine (non-glutamine group). Propensity score matching method was used to analyze and compare postoperative complications and other outcome indicators. A total of 208 patients were reviewed, and 53 were included in each group post matching. While no significant difference in the time to first solid food intake between the two groups was observed, the glutamine group had a significantly reduced incidence of postoperative complications, shorter length of hospital stay, and shorter time to first defecation, first exhaust, and first fluid diet intake than those of the control group. Moreover, glutamine alleviated the reduction in albumin and prealbumin levels. Perioperative parenteral glutamine supplementation effectively reduces the incidence of postoperative complications, promotes postoperative recovery, and improves albumin levels in patients undergoing RC surgery and receiving NT.

Framework, component, and implementation of enhanced recovery pathways

The introduction of enhanced recovery pathways (ERPs) has led to a considerable paradigm shift towards evidence-based, multidisciplinary perioperative care. Such pathways are now widely implemented in a variety of surgical specialties, with largely positive results. In this narrative review, we summarize the principles, components and implementation of ERPs, focusing on recent developments in the field. We also discuss ‘special cases’ in ERPs, including: surgery in frail patients; emergency procedures; and patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/COVID-19).