Clinical efficacy of immunonutrition support in perioperative period of hepatectomy: a Meta analysis
10.3760/cma.j.issn.1673-9752.2019.10.011
- VernacularTitle: 肝切除术围术期行免疫营养支持治疗临床疗效的Meta分析
- Author:
Haonan GUAN
1
;
Qiang HUANG
;
Chenhai LIU
;
Xiansheng LIN
;
Ji YANG
;
Sanwei CHEN
;
Cheng WANG
Author Information
1. Department of Biliary and Pancreatic Surgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hepatopancreatobiliary Key Laboratory of Anhui Province, Hefei 230001, China
- Publication Type:Journal Article
- Keywords:
Liver neoplasms;
Cholelithiasis;
Hepatectomy;
Nutritional support;
Immunonutrition;
Perioperative period;
Complications;
Randomized control trial;
Meta analysis;
Safety;
Efficacy
- From:
Chinese Journal of Digestive Surgery
2019;18(10):951-959
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically evaluate the clinical efficacy of immunonutrition support in perioperative period of hepatectomy.
Methods:Literatures were researched using CNKI，CBM，Wanfang database，VIP databases，PubMed (Medline)，Embase，Web of science，Science Direct，Cochrane Center from January 1996 to March 2018 with the key words including "肝切除术，免疫营养，hepatectomy，hepatic resection，immunonutrition，immunoenhanced nutrition" . The randomized controlled trials (RCTs) on comparison of efficacy of immunonutrition support versus routine nutritional support in perioperative period of hepatectomy. Patients in the immunonutrition group received immunonutrition support in perioperative period of hepatectomy，and patients in the routine nutrition group received routine nutritional support in perioperative period of hepatectomy. Outcome measures：overall incidence of postoperative complications，incidence of postoperative infectious complications，incidence of postoperative liver failure，perioperative mortality，hospital stay，and hospitalization expenses. Literatures screening，data extraction and quality assessment of methodology were conducted by two researchers separately. Count data were represented as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) or weighted mean difference (WMD) and 95%CI. Heterogeneity of the included studies was analyzed with I2. Funnel plot was used to test potential publication bias if the number of studies included ≥ 10，and funnel plot was used to test potential publication bias for the outcome measures with the maximum number of studies if the number of studies included <10.
Results:(1) Document retrival: 12 RCTs were enrolled in the Meta analysis, and the total sample size was 1 136 patients, including 568 patients in the immunonutrition group and in the routine nutrition group, respectively. (2) Results of Meta-analysis: the that immunonutrition group had lower overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and hospital stay (RR=0.57, 0.49, 0.30, MD=-3.28, 95%CI: 0.46-0.71, 0.37-0.65, 0.12-0.74, -4.45 to -2.11, P<0.05), and higher hospital expenses (MD=11.86, 95%CI: 10.96-12.77, P<0.05) compared with the routine nutrition group. There was no significant difference in the perioperative mortality between the two groups (RR=0.26, 95%CI: 0.07-1.05, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies comparing incidence of postoperative infectious complications between the immunonutrition group and routine nutrition group, suggesting that publication bias had little influence on results of Meta-analysis.
Conclusions:Perioperative immunonutrition support for hepatectomy is safe and feasible. Compared with routine nutritional support, immunonutrition support can significantly reduce overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and shorten the hospital stay without increasing postoperative mortality.
