PD1038 - IMPACT OF IMMUNONUTRITION ON POSTOPERATIVE OUTCOMES AFTER PANCREATICODUODENECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

PD1038

IMPACT OF IMMUNONUTRITION ON POSTOPERATIVE OUTCOMES AFTER PANCREATICODUODENECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

C. FRANCO BORRAS^1,2,*, M. C. Pavel^3,4,5, R. Memba Ikuga^3,4, M. E. Solano^1,2, A. Megia^1,6,7, R. Jorba ^3,4,5

¹Rovira i Virgili University, Tarragona, Spain, ²Endocrinology and Nutrition Department, Joan XXIII University Hospital, ³Hepato-Pancreato-Biliary Surgery Unit, Department of General Surgery, Joan XXIII University Hospital , ⁴Research Group in General and Digestive System Surgery (RECERCGAD), Joan XXIII University Hospital , ⁵Complex Surgical Patient Area, Joan XXIII University Hospital, Tarragona, ⁶Department of Endocrinology and Nutrition. Research Unit. Joan XXIII University Hospital-Institut d´Investigació Sanitària Pere Virgili (IISPV), tarr, ⁷Diabetes and Associated Metabolic Diseases Research Group (CIBERDEM) – Instituto de Salud Carlos III, Madrid, Spain

Rationale: Pancreaticoduodenectomy (PD) is associated with high postoperative morbidity, particularly infectious complications and prolonged hospital stay. The aim of this study is to evaluate the effect of immunonutrition (IN) on postoperative outcomes after PD and to assess efficacy according to formula, timing, comparator, and study design.

Methods: A systematic review and meta-analysis was performed according to predefined PICO criteria. Studies comparing IN with standard nutrition (oral diet, standard enteral nutrition, or total parenteral nutrition) in patients undergoing PD were included. The primary outcome was overall postoperative infectious complications. Secondary outcomes included surgical site infection, pancreatic fistula, delayed gastric emptying, length of hospital stay and mortality. Random-effects meta-analyses and prespecified subgroup analyses were conducted.

Results: Thirteen studies met eligibility criteria. IN significantly reduced overall infectious complications. In subgroup analysis by formula, arginine-, omega-3 fatty acid– and nucleotide-enriched formulas (IMPACT®) were associated with a significant reduction in infections (risk ratio [RR] 0.56, 95% confidence interval [CI] 0.40–0.78), whereas other formulas did not reach statistical significance. The benefit was observed versus standard diet and total parenteral nutrition, but not versus standard enteral nutrition. Preoperative administration was associated with a significant reduction in infections, while perioperative administration showed no clear benefit. IN significantly reduced length of hospital stay by more than 2 days. No significant effects were observed for other postoperative complications or mortality.

Conclusion: IN, when administered preoperatively and using specific formulations, reduces infectious complications and length of hospital stay after PD.

Disclosure of Interest: None declared