Publications by authors named "Lucyna Scislo"

15 Publications

  • Page 1 of 1

From hospital unit to intestinal failure center: Twenty years of history.

Clin Nutr 2021 Jun 27;40(6):3787-3792. Epub 2021 Apr 27.

Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Care, Jagiellonian University, Krakow, Poland.

Aim: Home parenteral nutrition (HPN) is one of the most demanding medical therapies as it is the only option for patients for intestinal failure (IF). No unequivocal policy on how to start and progress with HPN has ever been presented. The IF Center at the Stanley Dudrick's Memorial Hospital in Skawina is one of the biggest centers in Poland, celebrating its twentieth birthday last year. It offered the unique chance to present how to create and grow the IF center, increasing the quality of care. The above became the aim of this study.

Methods: A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. Patient profile, clinical course and treatment outcomes were assessed. The evolution of all aspects of HPN is presented. A brief historical perspective has been added to better illustrate the center's growth and transformation.

Results: 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). The most common primary disease was cancer (n = 267), followed by mesenteric ischemia (n = 104), and surgical complications (n = 62). 314 patients (51.8%) died. 73 (12.04%) were successfully weaned off PN. The catheter infection rate reached 0.39/1000 catheter days.

Conclusions: the founding of the HPN center and its further development is possible provided that there is team of dedicated people, supported by hospital base. The real growth opportunity is guaranteed by the reimbursement. It is necessary to adapt to the changing circumstances.
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http://dx.doi.org/10.1016/j.clnu.2021.04.027DOI Listing
June 2021

Sociodemographic Factors Affecting Older People's Care Dependency in Their Daily Living Environment According to Care Dependency Scale (CDS).

Healthcare (Basel) 2021 Jan 21;9(2). Epub 2021 Jan 21.

Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus, University in Torun, M.Skłodowskiej-Curie Str. 9, 67-090 Toruń, Poland.

The aim of the research was to determine the influence of sociodemographic factors on older people's care dependency in their living environment according to the Care Dependency Scale (CDS). The research was conducted in a group of 151 older people staying in their own homes. The methods applied in the research included a sociodemographic questionnaire and scales including the Abbreviated Mental Test Score (AMTS), CDS, Katz Index of Independence in Activities of Daily Living (ADL), Lawton's Instrumental Activities of Daily Living (I-ADL), Mini Nutritional Assessment (MNA), and Geriatric Depression Scale (GDS). Gender had a significant impact on the level of care dependency. The surveyed females obtained the medium or high level of dependency more often than males (22.4% vs. 6.1%), and the low level of dependency was significantly more frequent among men than women ( = 0.006). Moreover, the age of the respondents determined their level of care dependency. The subjects with a medium or high level of care dependency were significantly older ( = 0.001). The subjects with a low level of care dependency were more likely to be married than people with a medium/high level ( < 0.001). The level of education had a significant impact on care dependency. A higher level of education correlated with a medium/high level of dependency ( = 0.003). The survey results confirmed that sociodemographic factors have a significant impact on the level of care dependency. When planning care in the home environment, special attention should be paid to older women, who are more likely to lose their independence than men. These women should be given additional support.
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http://dx.doi.org/10.3390/healthcare9020114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910922PMC
January 2021

Intravenous lipid emulsions and liver function in adult chronic intestinal failure patients: Results after 5 y of home parenteral nutrition.

Nutrition 2021 02 18;82:111029. Epub 2020 Oct 18.

Second Department of General Surgery, Jagiellonian University Medical College, Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.

Objectives: Intravenous lipid emulsions (ILE) are an essential component of parenteral nutrition (PN); however, pure soybean oil emulsion is considered a risk factor for intestinal failure-associated liver disease (IFALD). Limited data are available on the effect of different ILEs on the liver during long-term PN, and to our knowledge, no study has evaluated outcomes beyond 12 mo. Therefore, the aim of the present study was to assess the influence of mixed ILEs on liver function during long-term PN.

Methods: A randomized, open-label clinical trial was performed at the Intestinal Failure Center in Skawina, Poland. Sixty-seven patients (35 F, 32 M; mean age, 53.2 years) receiving home parenteral nutrition (HPN) due to stable chronic intestinal failure (CIF) were randomized to receive one of the following three ILEs: medium/long-chain triacylglycerides (MCT/LCT), olive oil/soybean oil (OO/SO), or a combination of SO/MCT/OO/fish oil (FO) (SMOFlipid). Patients were followed for 5 y. Liver function was assessed clinically and with biochemical parameters (total bilirubin, serum glutamyl oxalate transaminase, serum glutamyl pyruvate transaminase, γ-glutamyl transpeptidase, and alkaline phosphatase) at baseline and after 24 and 60 mo.

Results: The most common etiology for CIF was vascular, followed by Crohn's disease, surgical complications, and radiation enteritis. HPN was effective in improving nutritional status and was associated with low rates of catheter infections and clinical complications. No significant differences were observed between groups in median concentrations serum glutamyl oxalate transaminase, serum glutamyl pyruvate transaminase, γ-glutamyl transpeptidase, or alkaline phosphatase at 24 or 60 mo. A significant reduction in median bilirubin concentration was observed in the SMOFlipid group at 60 mo compared with baseline (6.8 umol/L; interquartile range, 5.2-8.5 versus 7.7 umol/L; interquartile range, 4.9-12.4; P = 0.0138).

Conclusions: Mixed ILEs are safe and effective for use in patients on long-term HPN. A multicomponent ILE with FO can provide additional benefits in terms of liver function during long-term HPN.
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http://dx.doi.org/10.1016/j.nut.2020.111029DOI Listing
February 2021

High Dose Intravenous Fish Oil Reduces Inflammation-A Retrospective Tale from Two Centers.

Nutrients 2020 Sep 19;12(9). Epub 2020 Sep 19.

General Surgery Unit, Stanley Dudrick's Memorial Hospital, 15 Tyniecka Street, 32-050 Skawina, Poland.

Aim: Patients on parenteral nutrition (PN) are prone to inflammation. This may aggravate an existing proinflammatory state and become a critical factor in the development of liver dysfunction (LD). Intravenous fish oil may attenuate this inflammatory state, but data on its use in adults are scarce. The aim of this study was to investigate the effects of adding a pure fish oil intravenous lipid emulsion (ILE) into short- and long-term PN in patients either at risk of, or with existing, inflammation.

Methods: A retrospective analysis of 61 patients (32 female, 29 male, mean age 51.5 ± 12.6 years) who received all-in-one PN, including amino acids, glucose, and lipids supplemented with pure fish oil ILE, was performed. Pure fish oil ILE (Omegaven®, Fresenius Kabi, Bad Homburg, Germany) was used along with the standard ILE to reach a fish oil dose of 0.4-0.5 g fish oil/kg/d. Diagnoses were chronic intestinal failure (CIF, = 20), Crohn's disease (CD, = 22), and ulcerative colitis (UC, = 19). The observation period was 12 months for CIF and 21 days for UC and CD.

Results: A reduction in inflammation was noticeable in all patients and became statistically significant in CD (hsCRP < 0.0001, ESR = 0.0034, procalcitonin = 0.0014, Il-6 = 0.001) and UC groups (hsCRP and ESR < 0.0001, Il-6 = 0.0001, TNF-α = 0.0113). In the CIF group, the total bilirubin concentration ( = 0.2157) and aspartate transaminase SGOT ( = 0.1785) did not vary over time.

Conclusions: PN with pure fish oil ILE reduces some inflammatory parameters in IBD and maintains liver function parameters in CIF patients. Fish oil might become a valuable ingredient in both short- and long-term PN in patients at risk of liver dysfunction.
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http://dx.doi.org/10.3390/nu12092865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551918PMC
September 2020

Nutritional Status of Elderly Patients after Coronary Artery Bypass Surgery.

Int J Environ Res Public Health 2019 01 15;16(2). Epub 2019 Jan 15.

Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University, Medical College, ul.Kopernika 40, 31-00 Krakow, Poland.

Surgical trauma can result in immobilization of biological material, degradation of muscle proteins, synthesis of acute-phase proteins in the liver, occurrence of catabolism phase and anabolism simultaneously, and as a consequence weight loss and nutritional deficiencies. The aim of this study was to assess the nutritional status of patients with ischemic heart disease subjected to coronary artery bypass surgery and physical activity and postoperative complications. The analysis among 96 men included total number of lymphocytes (TNL), body mass index (BMI), case history of a patient and results of laboratory tests. The activities of daily living (ADL) and the mini nutritional assessment (MNA) questionnaires were used. According to TNL, before the procedure malnutrition occurred in 46% of patients. BMI revealed overweight in 62.5% and obesity in 26.0%. After the surgery, no changes were observed. According to MNA, 59% of patients before the surgery were at risk of malnutrition. After the operation, the number of people at risk of malnutrition increased by 50% ( < 0.0001). The correlation was noted between BMI and patients' efficiency in the fifth day after the surgery ( = 0.0031). Complications after the surgery occurred in 35.4% of patients. After the surgery, the risk of malnutrition increased, decreased activity and complications occurred more frequently in people with underweight, obesity, and overweight than in people with normal BMI.
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http://dx.doi.org/10.3390/ijerph16020226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352014PMC
January 2019

Intravenous lipid emulsions and liver function in adult chronic intestinal failure patients: results from a randomized clinical trial.

Nutrition 2018 11 22;55-56:45-50. Epub 2018 Mar 22.

Second Department of General Surgery, Jagiellonian University Medical College, Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.

Aim: Intravenous lipid emulsion (ILE) can become a risk factor for intestinal failure associated liver disease (IFALD). Many ILEs are commercially available, however, a direct comparison of their impact on liver has, to our knowledge, never been performed. The aim of the study was to analyse that clinical problem during long term parenteral nutrition (PN).

Methods: A randomized, controlled clinical trial was performed at the Intestinal Failure Center in Skawina, Poland. Sixty-seven patients (37 F, 30 M, mean age 53.9 years) enrolled in home parenteral nutrition (HPN) due to stable chronic intestinal failure (CIF) were randomized to receive one the following for 12 months: long-chain triglycerides (LCT), medium/long-chain triglycerides, olive oil/LCT (OO/LCT) and a mix of LCT/MCT/OO/fish oil. Clinical evaluation and biochemical tests (total bilirubin, SGOT, SGTP, GGPT, alkaline phosphatase) were performed at enrolment and after 6 and 12 months.

Results: the most common reason for intestinal failure (IF) was short bowel due to mesenteric ischaemia, followed by Crohn's disease, surgical complications and radiation enteritis. PN stabilized liver parameters in all patients. No essential fatty acids deficiency was diagnosed. All four ILEs demonstrated comparable influence on liver in all study periods. The only exception was the decrease in total bilirubin concentration after 12 months (28.1 ± 25.3vs 11.1 ± 4.5, p = 0.0023) and GGTP (222.5 ± 205.8vs 146.6 ± 197.7, p = 0.0079) when OO/LCT was in use.

Conclusions: All four ILEs tested may be safe even during long-term parenteral nutrition. OO/LCT may be more effective than the others, but more studies in the field are needed.
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http://dx.doi.org/10.1016/j.nut.2018.03.008DOI Listing
November 2018

The Impact of Postoperative Enteral Immunonutrition on Postoperative Complications and Survival in Gastric Cancer Patients - Randomized Clinical Trial.

Nutr Cancer 2018 04 13;70(3):453-459. Epub 2018 Mar 13.

b 1st Department of General, Oncological and Gastrointestinal Surgery , Jagiellonian University Medical College , Krakow , Poland.

Background: Immunomodulating enteral nutrition in the perioperative period may reduce postoperative complications in cancer patients. Little is known if this effect translates to the better survival. The aim of study was to assess the impact of postoperative immunomodulating enteral nutrition on postoperative complications and survival of gastric cancer patients.

Methods: A group of 98 gastric cancer patients was randomly assigned for postoperative immunomodulating enteral nutrition n = 44 (Reconvan, Fresenius Kabi, Bad Homburg, Germany), or standard enteral nutrition n = 54 (Peptisorb, Nutricia, Schipol, The Netherlands). Postoperative complications, mortality, 6-mo and 1-yr survival were analyzed.

Results: The overall postoperative morbidity did not differ between the groups. The rate of pulmonary complications (excluding pneumonia) was significantly lower in immunomodulation group (0% vs 9.3%, p = 0.044), as well as 60-day mortality (0% vs. 11.1%, p = 0.037). There was no difference in 6-mo and 1-yr survival between the groups.

Conclusions: Postoperative immunomodulating enteral nutrition may reduce respiratory complications and postoperative mortality in comparison to standard enteral nutrition. Despite this effect, it did not improve 6-mo and 1-yr survival in immunomodulation group. Probably the beneficial effect of immunomodulating enteral nutrition is too weak to be significant in such a number of patients.
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http://dx.doi.org/10.1080/01635581.2018.1445770DOI Listing
April 2018

[The model of perioperative risk assessment in elderly patients - interim analysis].

Pol Merkur Lekarski 2017 Apr;42(250):151-157

Jagiellonian University Medical College of Carcow, Poland: First Department of General Surgery, Faculty of Medicine.

Demographic changes in contemporary society require implementation of proper perioperative care of elderly patients due to an increased risk of perioperative complications in this group. Preoperative assessment of health status identifies risks and enables preventive interventions, improving outcomes of surgical treatment. The Comprehensive Geriatric Assessment contains numerous diagnostic tests and consultations, which is expensive and difficult to use in everyday practice. The development of a simplified model of perioperative assessment of elderly patients will help identifying the group of patients who require further diagnostic workup.

Aim: The aim of the study is to evaluate the usefulness of the tests used in a proposed model of perioperative risk assessment in elderly patients.

Materials And Methods: In a group of 178 patients older than 64 years admitted for surgical procedures, a battery of tests was performed. The proposed model of perioperative risk assessment included: Charlson Comorbidity Index, ADL (activities of daily living), TUG test (timed "up and go" test), MNA (mini nutritional assessment), AMTS (abbreviated mental test score), spirometry measurement of respiratory muscle strength (Pimax, Pemax). Distribution of abnormal results of each test has been analysed.

Results: The Charlson Index over 6 points was recorded in 10.1% of patients (15.1% in cancer patients). Abnormal result of the TUG test was observed in 32.1%. The risk of malnutrition in MNA test has been identified in 29.7% (39.2% in cancer patients).

Conclusions: Abnormal test results at the level of 10-30% indicate potential diagnostic value of Charlson Comorbidity Index, TUG test and MNA in the evaluation of perioperative risk in elderly patients.
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April 2017

Enriched enteral nutrition may improve short-term survival in stage IV gastric cancer patients: A randomized, controlled trial.

Nutrition 2017 Apr 25;36:46-53. Epub 2016 Mar 25.

Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland.

Objective: The aim of the study was to determine whether the postoperative use of enteral nutrition enriched with arginine, glutamine, and omega-3 fatty acids influences survival in patients diagnosed with stomach cancer. For the purpose of the study, the second wave of the trial performed in 2003 to 2009 was done.

Methods: Ninety-nine patients who underwent surgery for gastric cancer (27 F, 72 M, mean age: 62.9 y) met the inclusion criteria. Of those, 54 were randomized to standard and 45 to enriched enteral nutrition (EEN). In all patients, short- and long-term (5 y) survival was analyzed.

Results: Analysis of the overall survival time did not reveal differences between groups (P = 0.663). Until the end of the third month, however, there were nine deaths in the standard enteral nutrition group and no deaths in the EEN group (16.7% versus 0.0%, P = 0.004). The univariate analyses suggested that the EEN group may have lower risk, especially during the first year after intervention. A significant reduction in the risk of death was seen during the early period after surgery (first 6 mo) in the EEN group in stage IV patients (hazard ratio = 0.25, P = 0.049). The use of enriched enteral diet did not influence, however, the risk of dying when patients were analyzed together.

Conclusions: The study does not support the beneficial effect of enriched enteral nutrition in long-term survival; however, the positive impact on the stage IV patients suggests the need for further, more detailed studies.
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http://dx.doi.org/10.1016/j.nut.2016.03.016DOI Listing
April 2017

[Perioperative risk assessment tailored to elderly patients].

Pol Merkur Lekarski 2014 Sep;37(219):186-91

Proper preparation of the patient for surgery has a crucial impact on the outcome. Due to the continuous increase in life expectancy more and more often the problem of proper perioperative preparation of the patients over 65 years of age burdened with a higher risk of perioperative complications is undertaken. Proper assessment of the health condition and physical capacity allows to optimize treatment and thus minimize the risk of complications. In many countries, the recommended procedure is to perform the Comprehensive Geriatric Assessment (CGA), which, however, due to the need to carry out a number of additional diagnostic tests and consultations is too expensive for the vast majority of hospitals. Therefore the search for more convenient methods of abbreviated assessment is undertaken, the methods that will identify patients at greatest risk of complications. The Comprehensive Geriatric Assessment includes a series of tests and scales assessing, interalia, cognitive functions, motor efficiency, dependency, nutrition and mood. Applied abbreviated methods of perioperative assessment also have limitations in predicting the course of hospitalization. So far, there is no general practice guidelines for patients over 65 years of age. But it seems reasonable to perform the CGA in case of an unfavorable outcome of abbreviated assessment or when the threat of frailty syndrome is suspected. This procedure enables to select the best method of treatment, the implementation of appropriate prevention, thus improving the outcome of treatment and quality of life.
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September 2014

Perioperative nutrition in malnourished surgical cancer patients - a prospective, randomized, controlled clinical trial.

Clin Nutr 2011 Dec 5;30(6):708-13. Epub 2011 Aug 5.

Stanley Dudrick's Memorial Hospital, General Surgery Unit, 15 Tyniecka Street, 32-050 Skawina, Poland.

Background & Aims: Malnourished surgical patients are supposed to benefit from perioperative nutrition. It is unclear, however, whether enteral intervention really surpasses the parenteral one, and whether the modification of standard formula matters. The aim of the study was to evaluate the clinical value of the route and type of perioperative nutritional support.

Methods: A group of 167 malnourished patients (91 M, 76 F, mean age 61.4 years) operated between June 2001 and December 2008 was randomly assigned during postoperative period to four groups according to nutritional intervention: enteral and parenteral, standard or immunomodulating. All patients received parenteral nutrition before surgery for 14 days, which provided homogenous groups for the postoperative evaluation. The trial was designed to test the hypothesis that enteral nutrition and/or immunonutrition can reduce the incidence of postoperative complications.

Results: The incidence of individual complications was comparable among all four groups (p > 0.05). Infectious complications occurred in 23 of 84 patients with standard diets and in 20 of 83 patients receiving immunomodulatory formula (odds ratio 0.84; 95% CI 0.42 to 1.69). There were no significant differences in infectious complications' ratio in patients receiving enteral (24/84 patients) and parenteral formulas (19/83 patients). Neither immunomodulating formulas nor enteral feeding significantly affected the length of hospitalization, overall morbidity and mortality rates.

Conclusions: Results demonstrated that postoperative nutritional intervention generates comparable results regardless of the route and formula used and that preoperative intervention is of the utmost importance. The study was registered in the Clinical Trials Database - number: NCT 00558155.
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http://dx.doi.org/10.1016/j.clnu.2011.07.007DOI Listing
December 2011

IL-6 serum levels predict postoperative morbidity in gastric cancer patients.

Gastric Cancer 2011 Aug 20;14(3):266-73. Epub 2011 Apr 20.

1st Department of General and Gastrointestinal Surgery, Jagiellonian University Medical College, 40 Kopernika Str, 31-501, Kraków, Poland.

Background: Despite progress in surgical techniques and perioperative care, gastrectomy remains a procedure of significant morbidity. Several scoring systems and clinical measures have been adopted to predict postoperative complications in gastric cancer patients. The aim of this study was to investigate whether high serum levels of interleukin 6 (IL-6) in the early postoperative period may be a prognostic factor of postoperative morbidity.

Methods: A group of 99 consecutive patients with resectable gastric cancer were enrolled. The mean age was 62.9 years and the male/female ratio was 72:27. Subtotal gastric resection was performed in 22 patients and total gastric resection in 77. The IL-6 serum level was measured on the 1st postoperative day (POD).

Results: Complications were recorded in 28 patients (28.3%). The observed case-fatality rate was 3.03%. An IL-6 serum level of >288.7 pg/ml on the 1st POD in univariate and multivariate Cox proportional hazard models was an independent prognostic factor for overall complications and infective complications.

Conclusion: Our study showed an association between perioperative IL-6 serum levels and postoperative morbidity in gastric cancer patients. The IL-6 serum level on the 1st POD was shown to be an independent prognostic factor for both overall complications and infective complications.
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http://dx.doi.org/10.1007/s10120-011-0039-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159757PMC
August 2011

[The effect of immunomodulating enteral nutrition on postoperative cytokine profile in gastric cancer patients].

Pol Merkur Lekarski 2010 Oct;29(172):235-40

Uniwersytet Jagielloński, Collegium Medicum, II Katedra Chirurgii Ogólnej i Klinika Chirurgii Gastroenterologicznej, Kraków.

Unlabelled: The operative injury affects the immune system what results in cytokine production--mediators of immune response. Intensity of this reaction depends on the extent of surgery, the time of procedure and actual status of the immune system. In gastric cancer patients malnutrition is diagnosed in as much as 60-80% and increases postoperative morbidity, and the time to functional recovery. The implementation of immunonutrition correlates with the improvement of postoperative course. The aim of this study was to evaluate the influence of immunonutrition on postoperative cytokine (IL-6, IL-10, TNF-alpha) plasma levels in gastric cancer patients.

Material And Methods: The group of 99 gastric cancer patients was enrolled. In 54 patients standard postoperative enteral nutrition and in 45 patients immunonutrition was administered. Preoperatively and in 1., 3. and 7. postoperative day plasma levels of IL6, IL10 and TNFalpha were measured.

Results: The mean absolute levels of IL-6 and TNF-alpha did not differ statistically between the groups. However, the increment of changes of these cytokines was higher in immunonutrition group reaching statistical significance at day 7 for TNF-alpha (26 pg/ml for immunonutrition vs -10 pg/ml for standard nutrition p = 0.024). IL-10 levels were significantly higher in immunonutrition group at 1. and 3. postoperative days.

Conclusions: The postoperative profile of proinflammatory cytokines did not differ significantly between immunonutrition and standard nutrition groups. The increase of IL-10 plasma levels in early postoperative period in immunonutrition patients may suggest that one of the effects of this therapy is the inhibition of early inflammatory reaction.
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October 2010

The immunomodulating enteral nutrition in malnourished surgical patients - a prospective, randomized, double-blind clinical trial.

Clin Nutr 2011 Jun 13;30(3):282-8. Epub 2010 Nov 13.

1st Department of Surgery, Jagiellonian University Medical College, Krakow, Poland.

Background & Aim: The immunomodulating nutrition was supposed to reduce the incidence of complications in surgical patients, but many authors have questioned its value recently. The aim of the study was to assess the impact of enteral immunonutrition in postoperative period.

Methods: Between January 2003 and December 2009, 305 malnourished patients (123 F, 182 M, m. age 60.8) undergoing resection for pancreatic or gastric cancer, after preoperative 14 days of parenteral feeding, were randomized in double-blind manner to receive either postoperative immunomodulating enteral diet (IMEN) or standard oligopeptide diet (SEN). Outcome measures of the intend-to-treat analysis were: number and type of complications, length of hospitalization, mortality, and vital organ function.

Results: Median postoperative hospital stay was 17.1 days in SEN and 13.1 days in IMEN group (p = 0.006). Infectious complications were observed in 60 patients (39.2%) in SEN and 43 (28.3%) in IMEN group (p = 0.04). Differences were also observed in overall morbidity (47.1 vs 33.5%, p = 0.01) and mortality (5.9 vs 1.3%, p = 0.03), but the ratio of surgical complications, organ function, and treatment tolerance did not differ.

Conclusions: The study proved that postoperative immunomodulating enteral nutrition should be the treatment of choice in malnourished surgical cancer patients. The Clinical Trials Database registry number: NCT00576940.
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http://dx.doi.org/10.1016/j.clnu.2010.10.001DOI Listing
June 2011

Standard and immunomodulating enteral nutrition in patients after extended gastrointestinal surgery--a prospective, randomized, controlled clinical trial.

Clin Nutr 2008 Aug 20;27(4):504-12. Epub 2008 Jun 20.

1st Department of Surgery, Jagiellonian University Medical College, Krakow, Poland.

Background & Aim: The immunomodulating enteral diets are intended to reduce the incidence of postoperative complications in surgical patients. The aim of the study was to assess the clinical effect of such nutrition.

Materials And Methods: Between June 2004 and September 2007 196 well-nourished patients undergoing resection for pancreatic and gastric cancer were randomized in double-blind manner to receive postoperative enteral nutrition with immunostimulating diet (IMEN group) or standard oligopeptic diet (SEN group). Outcome measures were: number and type of complications, length of hospital stay, mortality, treatment tolerance, liver and kidney function.

Results: One hundred and ninety six patients were initially enrolled, finally 183 patients (91 SEN, 92 IMEN group; 69 F, 114 M, median age 61.2) were analyzed. Median postoperative hospital stay was 12.4 days (SD 5.9) in SEN and 12.9 days (SD 8.0) in IMEN group (p=0.42). Complications were observed in 21 patients (23.1%) in SEN and 23 (25.2%) in IMEN group (p>0.05). Four (4.4%) patients in SEN group and 4 (4.4%) in IMEN had surgical complications (p>0.05). There were no differences in liver and kidney function, visceral protein turnover and treatment tolerance.

Conclusion: Results of our study showed no benefit of immunomodulating enteral nutrition over standard enteral nutrition in patients after major gastrointestinal surgery. The Trial was registered in Clinical Trials Database--number: NCT00576940.
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http://dx.doi.org/10.1016/j.clnu.2008.04.010DOI Listing
August 2008