In the last year, several meta-analyses focused on the potential clinical benefits of perioperative immunonutrition in surgical patients. Purpose of this review is to summarize their results and to draw recommendations about the current indication of immunonutrition in surgery.
Standard enteral preparations have been modified by adding specific nutrients, such as arginine, omega-3 fatty acids and others, which have been shown to upregulate immune response, to control inflammatory response, and to improve gut function after surgery. The majority of the randomized trials found that perioperative immunonutrition improved short-term outcome in patients, who underwent elective major gastrointestinal (GI) surgery. Four meta-analyses including a large number of randomized clinical trials reported that perioperative immunonutrition is associated with a substantial reduction in both infection rate and length of hospital stay. These results have been found in both upper and lower GI patients, regardless of their baseline nutritional status. Promising results have been found also in head and neck surgery.
In the light of these findings the use of perioperative immunonutrition should be implemented in patients undergoing elective major GI surgery. This should result in a considerable reduction in both postoperative morbidity and costs for healthcare systems.
Larger trials are required before recommending immunonutrition as a routine practice in head and neck surgery.
Professor of Surgery, San Raffaele University, Milan, Italy
Correspondence to Professor Marco Braga, Department of Surgery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. Tel: +39 02 2643 2146; fax: +39 02 2643 2871; e-mail: firstname.lastname@example.org