The impact of immunonutrition on pancreaticoduodenectomy outcomes

Malnutrition is a significant risk factor for decreased survival in cancer patients undergoing a pancreaticoduodenectomy (PD). Our study aims to investigate the impact of immunonutrition on length of stay (LOS), infection rates, postoperative pancreatic fistula (POPF), and delayed gastric emptying (DGE).

This study retrospectively reviewed 344 patients who underwent PD between 2007 and 2018. Patients were on a regular diet or 5 days of preoperative immunonutrition. Statistical analyses were done via t-test and chi-square test with a significance cutoff of p < 0.05.

Immunonutrition was associated with increased intraabdominal infection (13% vs. 23%, p = 0.021), POPF (6% vs. 19%, p = 0.001), and decreased DGE (17% vs. 8%, p = 0.013). When patients were stratified by pathology, immunonutrition was not associated with POPF or infection rates in the pancreatic adenocarcinoma (PDAC) group. In the non-PDAC group, immunonutrition was associated with longer LOS (12.4 vs. 9.9 days, p = 0.02) and higher rates of intraabdominal infection (26% vs. 10%, p = 0.02) compared to the regular diet group.

In PDAC patients undergoing PD, preoperative immunonutrition did not have an impact on LOS, infections, POPF, or DGE. In non-PDAC patients, immunonutrition was associated with longer LOS and higher intraabdominal infections. Additional studies are needed to validate the routine use of immunonutrition in this patient population.