Impact of Oral Immunonutrition on Postoperative Morbidity in Digestive Oncologic Surgery: A Nation-wide Cohort Study

MINIImmunonutrition is prescribed systematically before major oncologic surgery to treat a potential malnutrition according to international guidelines. The preoperative use of immunonutrition is based on a decrease of infection and length of hospital stay after surgery. We report no association between immunonutrition and postoperative morbidity neither on infectious complications. OBJECTIVE:The objective of the present study was to assess the effect of preoperative immunonutrition on a nationwide scale. BACKGROUND:According to international guidelines, immunonutrition should be prescribed before major oncologic digestive surgery to decrease postoperative morbidity. Nevertheless, this practice remains controversial. METHODS:We used a prospective national health database named “Echantillon généraliste des Bénéficiaires.” Patients were selected with ICD10 codes of cancer and digestive surgery act-procedures from 2012 to 2016. Two groups were identifiedwith reimbursement of immunonutrition 45 days before surgery (IN-group) or not (no-IN-group). Primary outcome was 90-day severe morbidity. Secondary outcomes were postoperative length of stay (LOS) and overall survival. Logistic regression and survival analysis adjusted with IPW method were performed. RESULTS:One thousand seven hundred seventy-one patients were included. The proportion of different cancers was as follows72% patients were included in the colorectal group, 14% in the hepato-pancreato-biliary group, and 12% in the upper gastrointestinal group. Patients from the IN-group (n = 606, 34%) were younger (67.1 ± 11.8 vs 69.2 ± 12.2 years, P < 0.001), with increased use of other oral nutritional supplements (49.5% vs 31.8%, P < 0.001) and had more digestive anastomoses (89.4% vs 83.0%, P < 0.001). There was no significant difference between the 2 groups for 90-day severe morbidity [odds ratio (OR)0.91, 95% confidence interval (95% CI)0.73–1.14] or in survival (hazard ratio0.89, 95% CI0.73–1.08). LOS were shorter in the IN-group [−1.26 days, 95% CI−2.4 to −0.1)]. CONCLUSION:The preoperative use of immunonutrition before major oncologic digestive surgery was not associated with any significant difference in morbidity or mortality. However, the LOS was significantly shorter in the IN-group.