ABSTRACT
BACKGROUND: Perioperative carbohydrate loading, increased protein intake, and immunonutrition may decrease postoperative complications. Studies on the topic have led to controversial results. METHODS: We searched Medline, EMBASE, and CENTRAL up to August 2018 for randomized trials comparing the effect of perioperative nutritional supplements (intervention) versus control on postoperative complications in patients undergoing gastrointestinal cancer surgery. Secondary outcomes included infectious complications and length of hospital stay (LOS). Random effects model was used to estimate the pooled risk ratio (RR) of treatment effects. Pooled mean difference (MD) was used to compare LOS. Heterogeneity was assessed using I2. Sources of heterogeneity were explored through subgroup analysis by nutritional supplementation protocol, type of surgery, and type of nutritional supplement. Risk of bias and quality of the evidence were assessed. RESULTS: Of 3951 articles, we identified 56 trials (n = 6370). Perioperative nutrition was associated with a lower risk of postoperative complications (RR 0.74, 95% confidence interval (CI) 0.69-0.80); postoperative infections (RR 0.71, 95% CI 0.64-0.79, n = 4582); and postoperative non-infectious complications (RR 0.79, 95% CI 0.71-0.87, n = 4883). There were no significant heterogeneity outcomes analyzed (I2 = 14%, 1%, and 7%, respectively). LOS was shorter for the intervention group, MD - 1.58 days; 95% CI - 1.83 to - 1.32; I2 = 89%). Subgroup analysis did not identify sources of heterogeneity. The quality of evidence for postoperative complications was high and for LOS was moderate. CONCLUSION: Perioperative nutritional optimization decreases the risk of postoperative infectious and non-infectious complications. It also decreases LOS in patients undergoing gastrointestinal cancer surgery, but these findings should be taken with caution given the high heterogeneity.
Subject(s)
Dietary Supplements , Digestive System Surgical Procedures , Nutritional Status , Perioperative Care/methods , Postoperative Complications/prevention & control , Humans , Length of Stay/trendsABSTRACT
BACKGROUND: Positron emission tomography (PET), alone or combined with computed tomography (CT), potentially enhances detection of occult metastatic colorectal cancer. METHODS: We compared the impact of PET/PET-CT with conventional imaging, versus conventional imaging alone, in patients with potentially resectable colorectal cancer liver metastases. MEDLINE, EMBASE, and CENTRAL were searched for studies investigating PET/PET-CT to determine resectability. Outcomes included overall (OS), disease-free survival (DFS), change in surgical management, and futile laparotomy. Evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A pre-specified protocol was registered in PROSPERO. RESULTS: Of 4034 articles, two randomized trials (nâ¯=â¯554), and 11 non-randomized studies (nâ¯=â¯2251) were included. PET/PET-CT did not improve OS (hazard ratio [HR] 0.94, 95% CI 0.69-1.26, moderate quality) or DFS (HR 1.01, 95% CI 0.82-1.26, moderate quality). In the two trials, PET/PET-CT changed surgical management in 8% of cases (95% CI 5-11%, high quality), and did not significantly reduce futile laparotomies (risk ratio 0.59, 95% CI 0.24-1.47, low quality). Among non-randomized studies, PET/PET-CT changed surgical management in 20% of cases (95% CI 17-22%, very low quality) and reduced futile laparotomies (odds ratio 0.51, 95% CI 0.32-0.81, very low quality). CONCLUSIONS: Moderate-quality evidence suggests that preoperative PET/PET-CT does not improve OS or DFS in patients with colorectal cancer liver metastases. These results do not support routine use of PET/PET-CT in patients with potentially resectable disease. The main limitation of this study was the lack of randomized studies.
