The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries: a systematic review and meta-analysis

Stephen Knight, Ahmad U. Qureshi, Thomas Drake, Marie Carmela M Lapitan, Mayaba Maimbo, Edwin Mwintiereh Ta-Ang Yenli, Stephen Tabiri, Dhruva Ghosh, Pamela Alice Kingsley, Sudha Sundar, Katie Shaw, Apple Valparaiso, Aneel Bhangu, Peter Brocklehurst, Laura Magill, Dion G. Morton, John Norrie, Tracey E. Roberts, Evropi Theodoratou, Thomas WeiserSorrel T. Burden, Ewen M Harrison

Research output: Contribution to journalArticlepeer-review

Abstract

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, I 2  = 0%, n = 891), infection (0.52, 0.40-0.67, P = 0.008, I 2  = 0%, n = 570) and all-cause mortality (0.35, 0.26-0.47, P = 0.014, I 2  = 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.

Original languageEnglish
Article number12456
JournalScientific Reports
Volume12
Issue number1
DOIs
Publication statusPublished - 21 Jul 2022

Keywords

  • Developing Countries
  • Dietary Supplements
  • Digestive System Surgical Procedures/adverse effects
  • Gastrointestinal Neoplasms/surgery
  • Humans
  • Malnutrition
  • Postoperative Complications/etiology

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