Table 2.
Characteristics of randomised controlled trials of immune-enhancing enteral nutrition versus controlled group
| Author (year) | Study design and level of evidence* | Number of participant | Intervention group (IMN) | Standard control group | Clinical diagnosis before surgery | Nature of surgery | Outcome measured | Intervention | |
|---|---|---|---|---|---|---|---|---|---|
| Immunonutrition | Control | ||||||||
| Fan et al. (1994)26 | RCT, single centre, level 1b | 150 | 64 | 60 | HCC | Major and minor hepatectomy | Mortality and overall postoperative morbidity, changes in anthropometric measurements, and liver and immunologic function | 35% BCAAs, at a dosage of approximately 1.5 g of amino acid/kg/day, and dextrose and lipid emulsion (50% medium-chain triglycerides) providing 30 kcal/kilogram/day (in addition to their usual oral diet) | 5% percent dextrose and normal saline (in additional to usual oral diet) |
| San-In Group of Liver Surgery (1997)27 | RCT, single centre, level 1b | 150 | 67 | 65 | HCC | Major and minor liver resection | Clinical features, biochemical changes, recurrence and overall survival | BCAAs (420 kcal or 1758 kJ/day) | Conventional meals |
| Meng et al. (1999)28 | RCT, single centre, level 1b | 50 | 21 | 23 | HCC | Major and minor liver resection | Clinical features, blood results, neuropsychiatric symptoms, anthropometric measurements, morbidity, mortality and recurrence | BCAAs with 80 g protein and 8946 kJ/day | Normal diet of 80 g protein and 6300 kJ/day |
| Okabayashi et al. (2008)29 | RCT, single centre, level 1b | 112 | 40 | 72 | HCC | Major and minor liver resection | Laboratory data, postoperative complications, duration of hospitalisation, and survival | BCAAs (420 kcal/day) | Normal meals |
| Mikagi et al. (2011)30 | RCT, single centre, level 1b | 41 | 13 | 13 | HCC, cholangiocarcinoma, metastatic liver cancer and carcinoid | Major and minor hepatectomy | Postoperative complications and duration of hospitalisation | 750 ml/day IMPACT and half meals (1000 kcal/day) | Conventional hospital meals (1800 kcal/day) |
| Wu et al. (2012) | RCT, single centre, level 1b | 69 | 31 | 32 | HCC | Hepatectomy (non -specify) | Clinical outcomes- including infection-related complications and length of hospital stay | TPN (amino acids, glucose, a soybean oil emulsion with omegat-3 fatty acid supplementation) | TPN (amino acids, glucose, a soybean oil emulsion without omegat-3 fatty acid supplementation) |
| Gong et al. (2016)32 | RCT, single centre, level 1b | 119 | 59 | 60 | Liver cancer, liver metastasis and intrahepatic bile duct lithiasis | Major and minor hepatectomy | Post-operative complications, mortality and duration of hospital stay | Omegaven 10% 100 mL/day rather than regular nutrition | Regular nutrition (fat emulsion, amino acids (17AA) and glucose (11%) injection (KabivenTM PI, Sino-Swed) 1920 ml/day |
| Seguin et al. (2016)33 | RCT, single centre, level 1b | 35 | 18 | 17 | Primary or secondary liver cancer with cirrhosis | Hepatectomy (non-specify) | Measurement of factor V and liver volume | 900 ml/day IMPACT and regular food | Medium-chain triglyceride, protein (Novartis Nutrition, Bern, Switzerland) and regular food |
| Uno et al. (2016)34 | RCT, single centre, level 1b | 64 | 20 | 20 | Cholangiocarcinoma | All major hepatectomy | Anti-inflammatory effects and surgical complications | Oral IMPACT with regular food (1000 kcal/day) | Regular food (2000 kcal/day) |
| Kikuchi et al. (2016)35 | RCT, single centre, level 1b | 80 | 39 | 38 | HCC | Hepatic resection unspecified | Postoperative ascites and other complications, morbidity and hospital stay | BCAAs granules | Usual daily meals |
| Zhang et al. (2017)36 | RCT, single centre, level 1b | 320 | 157 | 155 | HCC, intrahepatic cholangiocellular carcinoma and colorectal cancer liver metastases | Hepatectomy unspecified | Postoperative recovery, complications, duration of hospital stay and surgical mortality | Glucose, lipid emulsion (20% structolipid and 10% n-3 fatty acid), amino acids, vitamins and electrolytes were compounded in an “All-In-One” manner | Glucose, lipid emulsion (20% structolipid), amino acids, vitamins and electrolytes were compounded in an “All-In-One” manner |
IMN, Immunonutrition; HCC, hepatocellular carcinoma; BCAAs, branched chain amino acids; EPA, eicosapentaenoic acid; TPN, total parenteral nutrition