Preoperative oral immunonutrition versus standard preoperative oral diet in well nourished patients undergoing pancreaticoduodenectomy.
BACKGROUND
Pancreaticoduodenectomy is still associated to high morbility, especially due to pancreatic surgery related and infectious complications: many risk factors have already been advocated. Aim of this study is to evaluate the role of preoperative oral immunonutrition in well nourished patients scheduled for pancreaticoduodenectomy.


METHODS
From February 2014 to June 2015, 54 well nourished patients undergoing pancreaticoduodenectomy were enrolled for 5 days preoperative oral immunonutrition. A series of consecutive patients submitted to the same intervention in the same department, with preoperative standard oral diet, was matched 1:1. For analysis demographic, pathological and surgical variables were considered. Mortality rate, overall postoperative morbility, pancreatic fistula, post pancreatectomy haemorrhage, delayed gastric emptying, infectious complications and length of hospital stay were described for each groups. Chi squared test, Fisher's Exact test and Student's T test were used for comparison. Differences were considered statistically significant at p < 0.05. Statistics was performed using a freeware Microsoft Excel (®) based program and SPSS v 10.00.


RESULTS
No statistical differences in term of mortality (2.1% in each groups) and overall morbility rate (41.6% vs 47.9%) occurred between the groups as well as for pancreatic surgery related complications. Conversely, statistical differences were found for infectious complications (22.9% vs 43.7%, p = 0.034) and length of hospital stay (18.3 ± 6.8 days vs 21.7 ± 8.3, p = 0.035) in immunonutrition group.


CONCLUSIONS
Preoperative oral immunonutrition is effective for well nourished patients scheduled for pancreaticoduodenectomy; it helps to reduce the risk of postoperative infectious complications and length of hospital stays.
4th General Surgery Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: silvestri.ste@gmail.com.
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Silvestri
4th General Surgery Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: afranchello@cittadellasalute.to.it.
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Franchello
4th General Surgery Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: giacomo.deiro@gmail.com.
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Deiro
Dietetics and Clinical Nutrition Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: rosalbagalletti@gmail.com.
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Galletti
4th General Surgery Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: dcassine@cittadellasalute.to.it.
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Cassine
4th General Surgery Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: dcampra@cittadellasalute.to.it.
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Campra
Dietetics and Clinical Nutrition Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: daria.bonfanti@alice.it.
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Bonfanti
Dietetics and Clinical Nutrition Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: lucadeca@alice.it.
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De Carli
Kidney Transplantation Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: fabrizio.fop@gmail.com.
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Fop
4th General Surgery Department, Azienda Ospedaliera ed Universitaria, Città della Salute e della Scienza, Corso Bramante 88, 10129, Turin, Italy. Electronic address: gfronda@libero.it.
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Fronda
D000368:Aged; D003138:Common Bile Duct Neoplasms / Q000178:diet therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010182:Pancreatic Diseases / Q000178:diet therapy* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D012307:Risk Factors
Hospital stay; Immunonutrition; Infectious complications; Pancreaticoduodenectomy; Preoperative nutrition