Efficacy of preoperative immunonutrition in locally advanced pancreatic cancer undergoing irreversible electroporation (IRE)

• Published in: European journal of surgical oncology Vol. 43; no. 4; pp. 772 - 779
• Main Authors: Martin, R.C.G, Agle, S, Schlegel, M, Hayat, T, Scoggins, C.R, McMasters, K.M, Philips, P
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2017
• Subjects: Ablation Techniques; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Amino Acids, Branched-Chain - therapeutic use; Arginine - therapeutic use; Dietary Supplements; Electroporation; Enteral Nutrition - methods; Fatty Acids, Omega-3 - therapeutic use; Female; Glutamine - therapeutic use; Hematology, Oncology and Palliative Medicine; Humans; Immunomodulation; Irreversible electroporation (IRE); Male; Middle Aged; Morbidity; Mortality; Nucleotides - therapeutic use; Nutritional Status; Pancreatic cancer; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - therapy; Pilot Projects; Postoperative Complications - prevention & control; Preoperative Care - methods; Preoperative nutrition; Surgery; Treatment Outcome; Weight Loss; mortality; pancreatic cancer; irreversible electroporation (IRE); morbidity; preoperative nutrition; surgery; Irreversible electroporation (IRE); Pancreatic cancer; Surgery; Mortality; Morbidity; Preoperative nutrition
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2017.01.002

Abstract Background Improved preoperative immunonutrition has been shown to decrease the length of stay (LOS) and complications among patients undergoing elective gastrointestinal cancer surgeries. The purpose of this study was to determine whether preoperative immunonutrition supplementation decreases postoperative LOS, infectious complications, and morbidity in patients undergoing irreversible electroporation (IRE) surgery for locally advanced pancreatic cancer (LAPC). Methods At a regional hepatopancreatobiliary referral center within an academic medical center 71 patients receiving IRE treatment of LAPC were included in the study. The participants were divided into those receiving preoperative immunonutrition (n=44) and those receiving no supplemental preoperative immunonutrition (n=27). Main outcomes and measures were LOS, postoperative complications, nutritional risk index (NRI), and albumin levels. Results Patients in both groups were similar for preoperative nutrition parameters and operative therapy. Patients in the immunonutrition group experienced a statistically significant decrease in postoperative complications (p=0.05) and LOS (10.7 vs. 17.4, p=0.01), and less of a decrease in nutritional risk index (-12.6 vs. -16.2, p=0.03) and albumin levels (-1.1 vs. -1.5, p<0.01). Conclusion Preoperative immunonutrition was clinically significant in decreasing postoperative complications, LOS, and improving post-surgery NRI and albumin levels in patients receiving elective IRE treatment of non-resectable pancreatic cancer. These results indicate that preoperative immunonutrition is effective and feasible in this subset of cancer patients.