Systematic review on immunonutrition in partial pancreatoduodenectomy

Background The effect of immunonutrition (IM) on postoperative outcomes has been investigated in gastrointestinal cancer surgery; however, strong evidence regarding IM in partial pancreatoduodenectomy (PD) is lacking. This study evaluated the effect of IM on short-term outcomes in patients undergoing PD. Methods A systematic literature review of randomized controlled trials was conducted to identify the studies investigating the IM effect on outcomes in PD. Random-effects meta-analyses were conducted to calculate the pooled risk ratio (RR). Studies were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results Five studies were included in the meta-analysis. IM was associated with a lower incidence of overall complications (RR 0.74; 95% confidence interval (CI) 0.58, 0.94;P = 0.01;I-2 = 0%) and infectious complications (RR 0.60; 95% CI 0.42, 0.84;P = 0.003;I-2 = 0%). However, no significant association was noted in the incidence of major complications (RR 0.68; 95% CI 0.41, 1.12;P = 0.13), mortality (RR 0.79; 95% CI 0.16, 3.99;P = 0.78), postoperative pancreatic fistula (RR 0.92, 95% CI 0.59, 1.46;P = 0.74), and delayed gastric emptying (RR 1.09; 95% CI 0.55, 2.15;P = 0.81). Conclusions IM administration in PD can prevent the incidence of overall and infectious complications postoperatively (GRADE recommendation: moderate). However, IM has no impact on major complications, mortality, and PD-specific complications (GRADE recommendation: low).