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M. Vayvada



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    ORAL 29 - MASCC-IASLC Joint Session: Palliative and Supportive Care (ID 136)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Palliative and Supportive Care
    • Presentations: 1
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      ORAL29.04 - The Impact of Perioperative Immunonutrition on Tissue Healing and Infection Related Morbidity in Patients Undergoing Lung Resection for NSCLC (ID 1462)

      17:18 - 17:29  |  Author(s): M. Vayvada

      • Abstract
      • Presentation
      • Slides

      Background:
      Despite several improvements in surgical techniques and postoperative management, tissue healing and infection related complications comprise substantial amount of morbidity associated with major lung resections. Perioperative use of immunomodulating diets in order to decrease the risk of acquired infections and wound complications remains controversial. This study aims to investigate the impact of perioperative immunonutrition over a standard regimen in decreasing tissue healing and infection related morbidity and if any, its relation to immune cell function in patients undergoing major lung resection for NSCLC.

      Methods:
      Seventy-eight patients undergoing a major lung resection for NSCLC were randomized into two groups to receive either study formula enriched with L-arginine, nucleotides and ω-3 polyunsaturated long-chain fatty acids (Group S; n=39) or isocaloric and isonitrogenous standard formula (Group C; n=39) starting at least 4 days prior to scheduled operation and discontinued on the 8th postoperative days at the earliest. At least half of the required daily calorie intake of each patient was supplied with their assigned nutrition formula. Primary outcome of the study was incidence of tissue healing and infection related morbidity, including prolonged air leak, bronchopleural fistula, wound infection, empyema, pneumonia and sepsis leading to prolonged hospital stay and/or both ICU and hospital readmissions. Leukocyte (WBC) and Lymphocyte counts, CRP, and ratio of CD4/CD8 were also obtained as secondary outcomes at 4 different time points (t1=Randomization; t2= 1st postoperative day; t3= Prior to discharge or 7th postoperative day; t4= 1st outpatient visit following discharge).

      Results:
      Demographic and preoperative clinical characteristics were comparable between the groups. All patients achieved targeted nutritional support during the study period. Incidence of tissue healing and infection related morbidity was significantly higher in Group C than in Group S [20 (51%) vs. 9 (23%); p=0.02)]. Cumulative rate of both ICU and hospital readmissions were also higher in Group C than in Group S [12 (31%) vs. 4 (10%), respectively; p=0.049], although this difference was not reflected to the median length of hospital stay [5 (4-7) vs. 5.5 (4-9) days, respectively; p=0.12]. Compared to randomization, WBC was significantly higher in Group C than in Group S throughout the postoperative period (8.0x10[3] vs. 8.1x10[3], 14.0x10[3] vs. 12.1x10[3], 12.2x10[3] vs. 10.4x10[3] and 11.8x10[3] vs. 9.8x10[3] for t1, t2, t3 and t4, respectively; p=0.01). Lymphocyte counts as percentages of total WBC declined considerably during the postoperative period in both groups; however this drop was significantly more evident in Group C than in Group S (22.7% vs. 23.5%, 10.2% vs. 16.7%, 14.8% vs. 18.9% and 16.8% vs. 18.7% for t1, t2, t3 and t4, respectively; p=0.01). Confirming the favorable effect on immunity, CD4/CD8 ratio was significantly higher in Group S during postoperative period, reaching its maximum value at t3 (1.6 vs. 1.5, 1.8 vs. 1.3, 2.2 vs. 1.5 and 2.0 vs. 1.4 for t1, t2, t3 and t4, respectively; p=0.02).

      Conclusion:
      This study suggests that supplementary immunonutrition enriched with L-arginine, nucleotides and ω-3 polyunsaturated long-chain fatty acids may help reducing the incidence of tissue healing and infection related complications in patients undergoing lung resection for NSCLC.

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