Preoperative immunonutrition in liver resection-a propensity score matched case-control analysis

BACKGROUND/OBJECTIVES: The value of preoperative nutritional support in liver resection remains questionable. The aim of the present study was to compare the incidence of postoperative complications after liver resection between those patients that received preoperative immunonutrition versus those patients without preoperative nutritional.support. SUBJECTS/METHODS: Patients undergoing elective liver resection between 9 November 2007 and 14 May 2013 were considered for the study: 84 with preoperative immunonutrition (Oral-Impact, Nestle, 3 x 237 ml per day for seven days at home) and 63 control patients without preoperative nutritional support. To reduce selection bias, propensity score matching was performed. Primary endpoint was the overall complication rate. Secondary endpoints were infectious and major complications. RESULTS: Ninety-eight patients could be matched (49 in each group). Seventy-seven patients (78.6%) had a minor and 21 patients (21.4%) a major liver resection. The two groups were balanced for age, gender distribution, American Society of Anesthesiology score >= 3, NRS 2002 score, weight loss > 10%, cirrhosis, steathosis, preoperative chemotherapy, pathology, major liver resection and extrahepatic procedures. No significant differences were observed in the overall complication rate (53.0% versus 51.0%), infectious complications (38.7% versus 28.5%) and major complications (12.2% versus 10.2%) for the immunonutrition and control group, respectively. CONCLUSIONS: The present study did not permit to demonstrate an impact of preoperative immunonutrition with Oral-Impact on postoperative complications after minor liver resection.