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BACKGROUND: Adult patients with an esophageal cancer can potentially be compromised with postoperative leaks or fistulae if patients' nutritional status is in a vulnerable stage. Currently in Australia, there is a growing need for clinicians to know whether use of immune-enhancing formulas (IEFs) containing Arg, omega-3, and RNA are a cost-effective approach compared with isonitrogenous-isocaloric formulas to reduce postoperative infectious complications in esophagectomy patients. Since IEFs may carry higher costs, this has led to inconsistencies in practice among clinicians and hospitals.
OBJECTIVE: Our aim is to compile and present the most up-to-date nutrition evidence available regarding the provision of IEFs containing Arg, omega-3, and RNA to help clinicians develop an evidence-based nutrition care plan; identify available evidence of whether an esophagectomy patient should receive IEF; determine the cost-effectiveness and safety of such nutrition; and determine appropriate administration quantity and timing (pre-, peri-, or postesophagectomy).
METHODS: This review will include RCTs involving the use of IEFs enriched with Arg, omega-3 polyunsaturated fatty acids, and RNA in the pre-, peri-, or postoperative period (for at least 5-7 days) given orally or via enteral feeding tube, in adult cancer patients undergoing esophageal resection. Lower gastrointestinal, gastric, or head cancer surgery with parenteral nutrition or non-IEF or use of isolated immunonutrient (Arg vs omega-3 vs RNA) will be excluded. Primary outcome comprises postoperative infectious complications. Secondary outcomes (pre/postoperatively) consist of cost-effectiveness, length of stay, survival/mortality, quality of life, nutritional status, percentage of weight loss, and biochemical changes. The risk of bias will be independently assessed by the reviewers, using a domain-based evaluation tool. Blinding will be assessed for subjective and objective outcome measures. Publication bias will be visually assessed by funnel plots. A meta-analysis will be generated by the Review Manager 5.3 software and represented in forest plots.
RESULTS: The first results are expected in 2018. Outlining the protocol will ensure transparency for the completed review.
CONCLUSIONS: This protocol for a systematic review and meta-analysis will enable a comprehensive appraisal of the literature to help determine whether overall institutional savings are associated with this approach. Findings will form a knowledge base relevant to stakeholders across the health system and researchers who are involved in decision making on evidence-based nutrition care plan pathways for patients undergoing esophagectomy, as well as the use of IEF, timing, and administration quantity.
TRIAL REGISTRATION: PROSPERO Registration Number: CRD42017056908; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp? ID=CRD42017056908 (Archived by WebCite at http://www.webcitation.org/6rLyeqaD6).
See also: Correction to this article
Isenring, E., Marshall, S., Reidlinger, D., Kelly, J., Cox, G., Van der Meij, B., MacKenzie-Shalders, K., Mayr, H., Dahl, C., Crichton, M., O'Bryan, K. R., Norris, R., Warner, M., Davidson, A., Naranjo, A., Mahoney, S., Eberhardt, F., Dalwood, P., Lopez, E., Hofto, S., Innerarity, C. & So, D.
1/01/14 → 31/12/27
Metadata correction: Immune-enhancing formulas for patients with cancer undergoing esophagectomy: Systematic review protocol (Journal of Medical Internet Research (2017) 6:11 (e214) DOI: 10.2196/resprot.7688)Naranjo, A., Isenring, E. & Teleni, L., 1 Apr 2018, In : Journal of Medical Internet Research. 20, 4, e61.
Research output: Contribution to journal › Comment/debate › Research › peer-reviewOpen AccessFile62 Downloads (Pure)