Optimal perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy: A systematic review with a component network meta-analysis

Shang Yu Wang; Yu Liang Hung; Chih Chieh Hsu; Chia Hsiang Hu; Ruo Yi Huang; Chang Mu Sung; Yan Rong Li; Hao Wei Kou; Ming Yang Chen; Shih Chun Chang; Chao Wei Lee; Chun Yi Tsai; Keng Hao Liu; Jun Te Hsu; Chun Nan Yeh; Ta Sen Yeh; Tsann Long Hwang; Yi Yin Jan; Miin Fu Chen

doi:10.3390/nu13114049

Optimal perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy: A systematic review with a component network meta-analysis

Shang Yu Wang
, Yu Liang Hung
, Chih Chieh Hsu
, Chia Hsiang Hu
, Ruo Yi Huang
, Chang Mu Sung
, Yan Rong Li
, Hao Wei Kou
, Ming Yang Chen
, Shih Chun Chang
, Chao Wei Lee
, Chun Yi Tsai
, Keng Hao Liu
, Jun Te Hsu
, Chun Nan Yeh^*
, Ta Sen Yeh
, Tsann Long Hwang
, Yi Yin Jan
, Miin Fu Chen

^*Corresponding author for this work

Chang Gung Memorial Hospital

Research output: Contribution to journal › Review article › peer-review

22 Scopus citations

Abstract

Numerous strategies for perioperative nutrition therapy for patients undergoing pancreati-coduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95% CI 0.02~0.72), Preop-IM (OR 0.22; 95% CI 0.08~0.62), and Preop-IM plus Postop-IM (OR 0.11; 95% CI 0.03~0.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95% CI 0.19~0.71) and Preop-IM plus Postop-IM (OR 0.21; 95% CI 0.06~0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.

Original language	English
Article number	4049
Journal	Nutrients
Volume	13
Issue number	11
DOIs	https://doi.org/10.3390/nu13114049
State	Published - 11 2021

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

Immunonutrition
Network meta-analysis
Nutrition therapy
Pancreaticoduodenectomy
Postoperative pancreatic fistula

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10.3390/nu13114049

Cite this

Wang, S. Y., Hung, Y. L., Hsu, C. C., Hu, C. H., Huang, R. Y., Sung, C. M., Li, Y. R., Kou, H. W., Chen, M. Y., Chang, S. C., Lee, C. W., Tsai, C. Y., Liu, K. H., Hsu, J. T., Yeh, C. N., Yeh, T. S., Hwang, T. L., Jan, Y. Y., & Chen, M. F. (2021). Optimal perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy: A systematic review with a component network meta-analysis. Nutrients, 13(11), Article 4049. https://doi.org/10.3390/nu13114049

@article{484de09430f24436a79abce593c28d12,

title = "Optimal perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy: A systematic review with a component network meta-analysis",

abstract = "Numerous strategies for perioperative nutrition therapy for patients undergoing pancreati-coduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95\% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95\% CI 0.02\textasciitilde{}0.72), Preop-IM (OR 0.22; 95\% CI 0.08\textasciitilde{}0.62), and Preop-IM plus Postop-IM (OR 0.11; 95\% CI 0.03\textasciitilde{}0.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95\% CI 0.19\textasciitilde{}0.71) and Preop-IM plus Postop-IM (OR 0.21; 95\% CI 0.06\textasciitilde{}0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.",

keywords = "Immunonutrition, Network meta-analysis, Nutrition therapy, Pancreaticoduodenectomy, Postoperative pancreatic fistula",

author = "Wang, \{Shang Yu\} and Hung, \{Yu Liang\} and Hsu, \{Chih Chieh\} and Hu, \{Chia Hsiang\} and Huang, \{Ruo Yi\} and Sung, \{Chang Mu\} and Li, \{Yan Rong\} and Kou, \{Hao Wei\} and Chen, \{Ming Yang\} and Chang, \{Shih Chun\} and Lee, \{Chao Wei\} and Tsai, \{Chun Yi\} and Liu, \{Keng Hao\} and Hsu, \{Jun Te\} and Yeh, \{Chun Nan\} and Yeh, \{Ta Sen\} and Hwang, \{Tsann Long\} and Jan, \{Yi Yin\} and Chen, \{Miin Fu\}",

note = "Publisher Copyright: {\textcopyright} 2021 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2021",

month = nov,

doi = "10.3390/nu13114049",

language = "英语",

volume = "13",

journal = "Nutrients",

issn = "2072-6643",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "11",

}

Wang, SY, Hung, YL, Hsu, CC, Hu, CH, Huang, RY, Sung, CM, Li, YR, Kou, HW, Chen, MY, Chang, SC, Lee, CW, Tsai, CY, Liu, KH, Hsu, JT, Yeh, CN, Yeh, TS, Hwang, TL, Jan, YY & Chen, MF 2021, 'Optimal perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy: A systematic review with a component network meta-analysis', Nutrients, vol. 13, no. 11, 4049. https://doi.org/10.3390/nu13114049

TY - JOUR

T1 - Optimal perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy

T2 - A systematic review with a component network meta-analysis

AU - Wang, Shang Yu

AU - Hung, Yu Liang

AU - Hsu, Chih Chieh

AU - Hu, Chia Hsiang

AU - Huang, Ruo Yi

AU - Sung, Chang Mu

AU - Li, Yan Rong

AU - Kou, Hao Wei

AU - Chen, Ming Yang

AU - Chang, Shih Chun

AU - Lee, Chao Wei

AU - Tsai, Chun Yi

AU - Liu, Keng Hao

AU - Hsu, Jun Te

AU - Yeh, Chun Nan

AU - Yeh, Ta Sen

AU - Hwang, Tsann Long

AU - Jan, Yi Yin

AU - Chen, Miin Fu

PY - 2021/11

Y1 - 2021/11

N2 - Numerous strategies for perioperative nutrition therapy for patients undergoing pancreati-coduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95% CI 0.02~0.72), Preop-IM (OR 0.22; 95% CI 0.08~0.62), and Preop-IM plus Postop-IM (OR 0.11; 95% CI 0.03~0.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95% CI 0.19~0.71) and Preop-IM plus Postop-IM (OR 0.21; 95% CI 0.06~0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.

AB - Numerous strategies for perioperative nutrition therapy for patients undergoing pancreati-coduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95% CI 0.02~0.72), Preop-IM (OR 0.22; 95% CI 0.08~0.62), and Preop-IM plus Postop-IM (OR 0.11; 95% CI 0.03~0.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95% CI 0.19~0.71) and Preop-IM plus Postop-IM (OR 0.21; 95% CI 0.06~0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.

KW - Immunonutrition

KW - Network meta-analysis

KW - Nutrition therapy

KW - Pancreaticoduodenectomy

KW - Postoperative pancreatic fistula

UR - https://www.scopus.com/pages/publications/85118900976

U2 - 10.3390/nu13114049

DO - 10.3390/nu13114049

M3 - 文献综述

C2 - 34836308

AN - SCOPUS:85118900976

SN - 2072-6643

VL - 13

JO - Nutrients

JF - Nutrients

IS - 11

M1 - 4049

ER -

Optimal perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy: A systematic review with a component network meta-analysis

Abstract

Bibliographical note

Keywords

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