UTILITY OF IMMUNONUTRITION IN PANCREATICODUODENECTOMY PATIENTS
Xuanji Wang*, Emanuel Eguia, Mary Varsanik, Sean Kisch, Gerard Abood, Lawrence Knab
General Surgery, Loyola University Medical Center, Maywood, IL
Introduction:
Immunonutrition has been used widely as a component of enhanced recovery after surgery protocols, which aim to decrease the length of hospital stay, infection rates, overall narcotics use, and more. Arginine, omega-3 fatty acids, and ribonucleic acids are components of immunonutrition that have been shown to improve immune response in the inflammatory pathway and enhance wound healing via activation of cell proliferation.
Most patients undergoing pancreaticoduodenectomy (PD) are characterized by cachexia, malnutrition, weight loss, and anorexia. Despite improvements in perioperative management and operative techniques in patients undergoing PD, malnutrition is a major risk factor of poor outcomes. The aim of this study was to examine the effects of perioperative immunonutrition in patients undergoing PD.
Methods:
We performed a single-center, retrospective study analyzing patients who underwent PD between 2007-2018. Our primary outcomes of interest included length of stay (LOS), infection, and in-hospital mortality. We compared outcomes before and after implementing immunonutrition at our institution. We used T-test, Chi Squared, multivariable regression (MVR) to analyze our outcomes of interest.
Results:
There was a total of 219 patients who underwent PD. The majority of the cases were for pancreatic adenocarcinoma (28%), cholangiocarcinoma (19%), ampullary adenocarcinoma (17%), and duodenal adenocarcinoma (5%). 60% received preoperative immunonutrition.
In comparison to the no-immunonutrition group, patients who received preoperative immunonutrition had similar age (65 vs. 65, p = 0.77), BMI (26.2 vs. 25.3, p = 0.20), and pre-existing comorbidities such as coronary artery disease (13 vs. 11, p = 0.52), HTN (57% vs. 56%, p = 0.94), HLD (28% vs. 25%, p = 0.65), diabetes (25% vs. 24%, p = 0.88), and smoking status (44% vs. 43%, p = 0.84). Both groups had similar levels of albumin, measured a minimum of 30 days prior to surgery (3.23 vs 3.18, p = 0.57). The immunonutrition group shorter LOS (11 days vs. 17 days, p = 0.18), similar rates of in-hospital mortality (3.8% vs. 3.4%, p = 0.90), and higher rates of infections (33% vs. 21% p = 0.05) compared to the non-immunonutrition group.
In our MVR, we found that patients who were on immunonutrition had shorter length by 6 days (R2= 0.01, F(2, 216)=1.14, p=0.32) and less infections (OR = 0.49 , p = 0.77).
Conclusion:
Our study supports the use of preoperative immunonutrition in patients undergoing PD. Optimizing pre-operative nutrition status, as measured by albumin, may be beneficial in association with decreased LOS and infections rates. The study was not powered to analyze in-hospital mortality. 
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