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Randomized Controlled Trial Investigating Perioperative Immunonutrition for Patients Undergoing Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Immunonutrition has been shown to reduce hospital stay and postoperative morbidity in patients undergoing gastrointestinal, and head and neck surgery. However, its use has not been demonstrated in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). This study aims to determine the effectiveness of perioperative immunonutrition on patients undergoing CRS-HIPEC in reducing length of hospitalization and postoperative complications.

Patients and Methods

From April 2017 to December 2018, patients undergoing CRS-HIPEC for peritoneal metastases in a single center were enrolled in a randomized controlled trial. Patients with evidence of intestinal obstruction or with diabetes mellitus were excluded. Patients were randomly assigned in a 1:1 fashion to receive perioperative oral immunonutrition or standard nutritional feeds. Length of hospital stay and rates of wound infection and complications were recorded and compared between the two groups in an intention-to-treat manner.

Results

A total of 62 patients were recruited and randomized into two groups. Compliance to nutritional feeds in the preoperative period was significantly higher in the standard nutrition group (95.2% versus 75.4%, p = 0.004). There was no difference in postoperative compliance rates. Length of hospital stay and rates of wound infection and postoperative complications were higher in the standard nutrition group when compared with patients on immunonutrition (15.5 versus 11.1 days, p = 0.186; 19% versus 9.7%, p = 0.473; 16% versus 9.7%, p = 0.653; respectively).

Conclusions

Patients undergoing CRS-HIPEC who received perioperative immunonutrition had shorter hospitalization and less wound infections and postoperative complications, although the differences with the standard nutrition group were not statistically significant. Potential benefits of perioperative immunonutrition need to be further evaluated in larger studies.

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Acknowledgements

We thank Ms. Lisa Mak and Ms. Thakshayeni Skanthakumar for their assistance in the conduct of the clinical trial.

Funding

The immunonutrition used in the trial was sponsored by Nestlé Singapore and was used only for the purposes of this trial. This study is supported by the National Cancer Centre Singapore (NCCS) Cancer Fund (Research) and the SingHealth Duke-NUS Academic Medicine Centre, facilitated by the Joint Office of Academic Medicine (JOAM). C.A.J.O. is supported by the National Medical Research Council Clinician Scientist-Individual Research Grant (CIRG21jun-0038). All the funding sources had no role in the study design, data interpretation, or writing of the manuscript.

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Authors and Affiliations

  1. Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre, Singapore, Singapore

    Grace Hwei Ching Tan MBBS, MMed, FRCS, Claramae Shulyn Chia MBBS, MMed, FRCS, Jolene Si Min Wong MBBS, MMed, FRCS, Hong-Yuan Zhu MBBS, PhD, Chin-Ann Johnny Ong MBBS, MMed, FRCS, PhD & Melissa Ching Ching Teo MBBS, MMed, FRCS, MPH

  2. Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore

    Grace Hwei Ching Tan MBBS, MMed, FRCS, Claramae Shulyn Chia MBBS, MMed, FRCS, Jolene Si Min Wong MBBS, MMed, FRCS, Hong-Yuan Zhu MBBS, PhD, Chin-Ann Johnny Ong MBBS, MMed, FRCS, PhD & Melissa Ching Ching Teo MBBS, MMed, FRCS, MPH

  3. Duke-NUS Medical School, SingHealth Duke-NUS Oncology Academic Clinical Program, Singapore, Singapore

    Claramae Shulyn Chia MBBS, MMed, FRCS, Jolene Si Min Wong MBBS, MMed, FRCS, Chin-Ann Johnny Ong MBBS, MMed, FRCS, PhD & Melissa Ching Ching Teo MBBS, MMed, FRCS, MPH

  4. Division of Clinical Trials & Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore

    Claramae Shulyn Chia MBBS, MMed, FRCS, Jolene Si Min Wong MBBS, MMed, FRCS, Whee Sze Ong MAppStats, Chin-Ann Johnny Ong MBBS, MMed, FRCS, PhD & Melissa Ching Ching Teo MBBS, MMed, FRCS, MPH

  5. Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore

    Hong-Yuan Zhu MBBS, PhD & Chin-Ann Johnny Ong MBBS, MMed, FRCS, PhD

  6. Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore

    Chin-Ann Johnny Ong MBBS, MMed, FRCS, PhD

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  1. Grace Hwei Ching Tan MBBS, MMed, FRCS
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Correspondence to Grace Hwei Ching Tan MBBS, MMed, FRCS.

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Tan, G.H.C., Chia, C.S., Wong, J.S.M. et al. Randomized Controlled Trial Investigating Perioperative Immunonutrition for Patients Undergoing Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Ann Surg Oncol 30, 777–789 (2023). https://doi.org/10.1245/s10434-022-12509-w

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