Key result
Preoperative oral nutrition cuts surgical complications ~47% and reduces mortality in LMIC GI cancer surgery.
Why the study?
Malnutrition is an independent predictor for postoperative complications in patients undergoing gastrointestinal cancer surgery in low- and middle-income countries, but the impact of preoperative oral nutrition supplementation in this setting was unclear.
Does preoperative oral nutrition supplementation reduce postoperative complications in patients undergoing gastrointestinal cancer surgery in LMICs?
Meta-Analysis (n=891)
Yes
Does preoperative oral nutrition supplementation reduce postoperative complications in patients undergoing gastrointestinal cancer surgery in LMICs?
Relative Risk: 0.53 (95% CI 0.46–0.6)
Absolute Event Rate: 17.9% vs 33.9%
Absolute Risk Reduction: 14%
Number Needed to Treat: 7
p-value: p=<0.001
Preoperative oral nutrition supplementation significantly reduces postoperative complications, infections, and mortality in patients undergoing gastrointestinal cancer surgery in LMICs.
Preoperative ONS may reduce complications, infections, and mortality after GI cancer surgery in LMICs; extends RCT evidence to resource-limited settings.
Malnutrition is an independent predictor for postoperative complications in low- and middle-income countries (LMICs). We systematically reviewed evidence on the impact of preoperative oral nutrition supplementation (ONS) on patients undergoing gastrointestinal cancer surgery in LMICs. We searched EMBASE, Cochrane Library, Web of Science, Scopus, WHO Global Index Medicus, SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) databases from inception to March 21, 2022 for randomised controlled trials evaluating preoperative ONS in gastrointestinal cancer within LMICs. We evaluated the impact of ONS on all postoperative outcomes using random-effects meta-analysis. Seven studies reported on 891 patients (446 ONS group, 445 control group) undergoing surgery for gastrointestinal cancer. Preoperative ONS reduced all cause postoperative surgical complications (risk ratio (RR) 0.53, 95% CI 0.46–0.60, P < 0.001, I2 = 0%, n = 891), infection (0.52, 0.40–0.67, P = 0.008, I2 = 0%, n = 570) and all-cause mortality (0.35, 0.26–0.47, P = 0.014, I2 = 0%, n = 588). Despite heterogeneous populations and baseline rates, absolute risk ratio (ARR) was reduced for all cause (pooled effect −0.14, −0.22 to −0.06, P = 0.006; number needed to treat (NNT) 7) and infectious complications (−0.13, −0.22 to −0.06, P < 0.001; NNT 8). Preoperative nutrition in patients undergoing gastrointestinal cancer surgery in LMICs demonstrated consistently strong and robust treatment effects across measured outcomes. However additional higher quality research, with particular focus within African populations, are urgently required.
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Knight et al. (2022) conducted a meta-analysis in Gastrointestinal cancer (n=891). Preoperative oral nutrition supplementation vs. Routine care with no additional dietary supplementation was evaluated on All-cause postoperative surgical complications at 30 days (RR 0.53, 95% CI 0.46-0.60, p=<0.001). Preoperative oral nutrition supplementation reduced all-cause postoperative surgical complications (RR 0.53) and all-cause mortality in patients undergoing gastrointestinal cancer surgery in LMICs.
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