Immunonutrition in elective colorectal surgery and early inflammatory response

Area of Science:

• Surgical Oncology
• Nutritional Science
• Immunology

Background:

• Immunonutrition is increasingly recognized in surgical guidelines, including ERAS protocols for colorectal surgery.
• While beneficial for malnourished cancer patients, its utility in other settings remains debated.
• This study investigates immunonutrition's impact on major colorectal surgery, irrespective of preoperative nutritional status.

Purpose of the Study:

• To assess the effect of preoperative immunonutrition on early postoperative outcomes and laboratory data in patients undergoing major elective colorectal surgery.
• To compare outcomes between patients receiving immunonutrition and a control group.

Main Methods:

• Retrospective analysis of a single-center database (January 2018 - February 2020).
• Implementation of a preoperative immunonutrition protocol in January 2019.
• Comparison of outcomes between the immunonutrition (IMN) group and a control (CTRL) group.

Main Results:

• The IMN group exhibited significantly lower total leukocytes and neutrophils on postoperative day 1 (P=0.004).
• A reduced rate of pathological leukocytosis was observed in the IMN group.
• Fewer patients in the IMN group required postoperative antibiotic treatment (P=0.047), though clinical outcomes were not significantly different.

Conclusions:

• Immunonutrition may modulate granulopoiesis and neutrophil activity, potentially enhancing tissue healing.
• This modulation could lead to reduced postoperative complications, even in normo-nourished individuals.
• The decreased need for antibiotics suggests improved resistance to postoperative infections.