Preoperative immunonutrition in patients undergoing liver resection: A prospective randomized trial

Table 1 Demographics and operative characteristics of patients who received either immunonutrition or standard care preoperatively

	Immunonutrition	Standard care
n	17	15
Male/Female	11/6	10/5
Age (yr)	61 (28 – 76)	63 (31–79)
SGA grade (A/B/C)	15/1/1	13/2/0
Indication for surgery
Metastatic disease	15	13
Hepatocellular carcinoma	2	1
Granulomatous liver disease	0	1
Hepatectomy
Major resection ( ≥ 3 segments)	14	10
Minor resection ( < 3 segments)	3	5
ASA grade (I/II/III)	1/9/6	0/8/6
Tissue removed (g)	815 ± 123	610 ± 94
Duration of surgery (min)	173 (104-337)	155 (128-246)

Data are number of patients, mean ± SE or median (range). SGA: Subjective global assessment; ASA: American Society of Anaesthesiologists physical status classification.

Table 2 Fatigue score and performance status measured at study entry, Day-1, POD 7 and POD 30 and grip strength measured at Day-1, POD7 and POD30 in patients who received either immunonutrition or standard care preoperatively

	Study entry	Day -1	POD 7	POD 30		P value1
					Group	Time	Group×Time
Fatigue score
STD group	4.2 ± 0.8	4.0 ± 0.6	7.1 ± 0.5	5.4 ± 0.7	0.121	< 0.0001	0.342
IMN group	4.3 ± 0.6	2.7 ± 0.4	6.7 ± 0.5	3.5 ± 0.8
Performance status
STD group	84.0 ± 3.9	85.7 ± 2.8	59.3 ± 4.2	73.5 ± 3.9	0.867	< 0.0001	0.810
IMN group	81.9 ± 2.8	86.8 ± 3.1	57.7 ± 4.8	75.0 ± 6.9
Grip strength (kg)
STD group	-	37.8 ± 2.7	35.4 ± 2.6	33.8 ± 2.3	0.825	0.019	0.849
IMN group	-	38.9 ± 3.4	36.5 ± 3.3	33.2 ± 2.4

¹Repeated measures analysis using the linear mixed model. Data are mean ± SE. POD: Postoperative day; IMN: Immunonutrition; STD: Standard care.

Table 3 Total lymphocyte and white cell counts over the pre-and postoperative periods in patients who received either immunonutrition or standard care preoperatively

	Preoperative		Postoperative					P value1
	Study entry	Day-1	POD 1	POD 3	POD 5	POD 10	POD 30	Group	Time	Group×time
Total lymphocytes (x109/L)
IMN group	1.41 ± 0.13	1.54 ± 0.12	0.93 ± 0.09	0.96 ± 0.10	0.95 ± 0.09	1.19 ± 0.09	1.47 ± 0.13	0.091	< 0.001		0.575
STD group	1.66 ± 0.16	1.78 ± 0.13	1.12 ± 0.15	1.21 ± 0.09	1.07 ± 0.13	1.38 ± 0.12	1.47 ± 0.10
White cell count (x109/L)
IMN group	5.80 ± 0.60	7.05 ± 0.78	12.78 ± 1.10	9.81 ± 1.29	7.40 ± 0.91	12.28 ± 2.27	6.80 ± 0.86	0.416	< 0.001		0.201
STD group	6.86 ± 0.83	6.75 ± 0.54	12.79 ± 1.32	8.99 ± 0.77	9.65 ± 0.98	13.53 ± 1.63	7.40 ± 0.68

¹Repeated measures analysis using the linear mixed model. Data are mean ± SE. POD: Postoperative day; IMN: Immunonutrition; STD: Standard care.

Table 4 All complications in patients who received either immunonutrition or standard care preoperatively

	IMN	STD	P value 1
Infectious complications
Urinary tract	3	0
Surgical site	2	2
Blood stream	5	0
Gastrointestinal	2	1
Lower respiratory tract	3	3
Non Infectious complications
AF/Bradycardia/Tachycardia	3	2
Acute kidney injury	3	0
Aspiration pneumonia	1	0
Acute respiratory distress syndrome	1	0
Atelectasis	7	6
Bowel obstruction	1	3
Diarrhoea	1	0
Electrolyte derangement	4	3
Encephalopathy	1	0
Hypotension	2	0
Ileus	4	2
Ischaemic optic neuropathy	1	0
Leak	1	0
Nausea and vomiting	1	2
Pleural effusion	5	3
Pain requiring epidural	2	0
Pneumothorax	1	0
Non infected collection	1	0
Wound dehiscence	1	0
Total infectious complications	15	6
Total non-infectious complications	40	21
Total complications	55	27
Patients with an infectious complication	10	4	0.087
Patients with a non-infectious complication	11	11	0.445
Patients with any complication	12	11	0.598
Severity of complication			0.047
Patients with major complication (Clavien-Dindo Grade ≥ III)	7	1
Patients with minor complication (Clavien-Dindo Grade < III)	5	10
Patients without any complication	5	4

¹Fisher’s exact test. AF: Atrial fibrillation; IMN: Immunonutrition; STD: Standard care.

Table 5 Severity of complications with major and minor surgery

	Severity of complication			P value1
	Major	Minor	No complication
Major surgery	6	11	7	1.000
Minor surgery	2	4	2

¹Fisher’s exact test.