P-0161 - The provision of a pre-operative immunomodulating diet in patients undergoing radical resection for upper gastrointestinal cancers does not reduce t...

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Supportive Care
Gastrointestinal Cancers
Surgery and/or Radiotherapy of Cancer
Presenter Petra Goldsmith
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors P. Goldsmith1, A. Tsoi2, J. Wyatt1, I. Khan1
  • 1University Hospital Aintree, Liverpool/UK
  • 2University of Liverpool, Liverpool/UK



There has been some limited research advocating the role of immunomodulating diets in reducing post-operative infective complications and length of stay in surgical patients undergoing gastrointenstinal surgery. It is a safe and low cost intervention. In our centre, we observed a higher rate than expected of post-operative chest infection in patients undergoing major radical resection for upper gastrointestinal cancers when compared to nationally published data. Local rates of chest infection were observed at 29.6% for oesophageal resection and 12.4% for gastric resection compared to 16.2% and 7.8% respectively in national data.


During the last 5 years, a proportion of our surgical patients have been given a short course of pre-operative oral immunomodulating diet with IMPACT ®. We thus performed a retrospective analysis to determine any effect such supplementation had on post-operative chest infection and other markers of improved recovery such as length of stay and mortality. Patients undergoing radical gastrectomy (total or partial) and oesophagectomy for malignancy between 1 January 2008 and 31 December 2013 were included in the analysis. Exclusions included patients who had undergone palliative procedures or wedge or sleeve gastric resection for gastrointenstinal stromal tumours.


A total of 254 patients undergoing upper gastrointestinal cancer resection were included in the analysis of which 53 (21%) received pre-operative IMPACT® supplementation. Of these, there were 128 oesophagectomy patients of which 36 (28%) received IMPACT® and 126 radical gastrectomy patients of which 17 (13.5%) received pre-operative IMPACT®. A total of 63 patients (24.8%) developed a post-operative chest infection of which 11 received pre-operative IMPACT and 52 did not (p = 0.48). Length of stay was similar in both groups: the IMPACT® group had a median stay of 15 days (IQR 10-22 days) and the no IMPACT® group had a shorter median length of stay of 12 days (IQR 9-20 days) (p = 0.8). Thirty day mortality was 4.5% in the no IMPACT® group and 1.8% in the IMPACT ® (p = 0.69).


Thus we have failed to demonstrate any benefit in reducing post-operative chest infection, length of stay or 30 day mortality rates with pre-operative dietary immunomodulation with IMPACT®. We acknowledge that this study is limited by its sample size, retrospective nature and lack of data regarding compliance.