title: Compliance with and effects of preoperative immunonutrition in patients undergoing pancreaticoduodenectomy.
abstract: OBJECTIVE
  This study was conducted to ascertain the feasibility and effectiveness of preoperative enteral immunonutrition using an immune-enhanced formula (Impact) in patients undergoing pancreaticoduodenectomy.
  
  
  METHODS
  Twenty-five patients undergoing an elective pancreaticoduodenectomy were asked to ingest Impact for 5 days (750 mL/day) prior to surgery in addition to their normal diets. We retrospectively compared the early postoperative outcomes of the Impact group (n = 18), which consisted of patients who fully complied with the study protocol, and a control group (n = 13), which consisted of patients who had not ingested Impact prior to surgery.
  
  
  RESULTS
  Overall, 82.6% of the patients complied with the preoperative oral ingestion of Impact; all but four patients tolerated a daily intake of 750 mL. While the clinical backgrounds of the Impact and control groups were not significantly different, the frequency of incisional wound infection was lower (0 vs. 30.8%, p = 0.012) and the change in systemic severity as evaluated using the acute physiology and chronic health evaluation (APACHE)-II scoring system was milder (p = 0.033) in the Impact group than in the control group.
  
  
  CONCLUSIONS
  The preoperative oral ingestion of Impact was well tolerated and appeared to be effective for preventing incisional wound infection and reducing the response to surgical stress in patients undergoing a pancreaticoduodenectomy.
authors.affiliation: Hepatobiliary Pancreatic Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan. hshiraka@tcc.pref.tochigi.lg.jp
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Shirakawa
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakagohri
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000601:surgery; D004338:Drug Combinations; D004379:Duodenal Neoplasms / Q000601:surgery; D004750:Enteral Nutrition / Q000379:methods*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010349:Patient Compliance; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012313:RNA / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D015525:Fatty Acids, Omega-3; D012313:RNA; D001120:Arginine