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|
|Topics|| Supportive Care
Surgery and/or Radiotherapy of Cancer
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
P. Goldsmith1, A. Tsoi2, J. Wyatt1, I. Khan1
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.