title: Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study).
abstract: To compare immunonutrition versus standard high calorie nutrition in patients undergoing elective colorectal resection within an Enhanced Recovery After Surgery (ERAS) program.Despite progress in recent years in the surgical management of patients with colorectal cancer (ERAS programs), postoperative complications are frequent. Nutritional supplements enriched with immunonutrients have recently been introduced into clinical practice. However, the extent to which the combination of ERAS protocols and immunonutrition benefits patients undergoing colorectal cancer surgery is unknown.The SONVI study is a prospective, multicenter, randomized trial with 2 parallel treatment groups receiving either the study product (an immune-enhancing feed) or the control supplement (a hypercaloric hypernitrogenous supplement) for 7 days before colorectal resection and 5 days postoperatively.A total of 264 patients were randomized. At baseline, both groups were comparable in regards to age, sex, surgical risk, comorbidity, and analytical and nutritional parameters. The median length of the postoperative hospital stay was 5 days with no differences between the groups. A decrease in the total number of complications was observed in the immunonutrition group compared with the control group, primarily due to a significant decrease in infectious complications (23.8% vs. 10.7%, P = 0.0007). Of the infectious complications, wound infection differed significantly between the groups (16.4% vs. 5.7%, P = 0.0008). Other infectious complications were lower in the immunonutrition group but were not statistically significantly different.The implementation of ERAS protocols including immunonutrient-enriched supplements reduces the complications of patients undergoing colorectal resection.This study is registered with ClinicalTrial.gov: NCT02393976.
authors.affiliation: From the Department of General Surgery (PM, AA), Division of Colorectal Surgery, University General Hospital of Elche, Elche; Department of Hospital Pharmacy (LS-I), University General Hospital of Elche, Elche; Department of General Surgery (JMR), Division of Colorectal Surgery, University Clinic Hospital Lozano Blesa, Zaragoza; Department of General Surgery (AG), Division of Colorectal Surgery, Hospital of Torrevieja, Torrevieja; Department of General Surgery (OB), Division of Colorectal Surgery, Virgen del Puerto Hospital, Plasencia; Department of General Surgery (FJB), Division of Colorectal Surgery, University Hospital of La Ribera, Alzira; Department of General Surgery (CB), Division of Colorectal Surgery, Hospital of Manacor, Manacor; and Department of Anesthesia (EM), University General Hospital of Elche, Elche, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moya
authors.forename: Leticia
authors.initials: L
authors.lastname: Soriano-Irigaray
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Ramirez
authors.forename: Alessandro
authors.initials: A
authors.lastname: Garcea
authors.forename: Olga
authors.initials: O
authors.lastname: Blasco
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Blanco
authors.forename: Carlo
authors.initials: C
authors.lastname: Brugiotti
authors.forename: Elena
authors.initials: E
authors.lastname: Miranda
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013030:Spain; D013530:Surgical Wound Infection / Q000517:prevention & control