Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study)

Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study)

Moya P, Soriano-Irigaray L, Ramirez JM, Garcea A, Blasco O, Blanco FJ, Brugiotti C, Miranda E, Arroyo A. (2016) Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study). Medicine (Baltimore). 2016 May;95(21):e3704.

What is already known: The evidence base for recommending immunonutrition is low and current ESPEN guidelines only recommend it for malnourished patients undergoing major cancer surgery. However, the most recent ERAS society guidelines do recommend immunonutrition based more on lack of harm rather than the quality of evidence base. This study is a multicentre RCT comparing an immune enhancing feed with a hypercaloric high-protein supplement in all patients undergoing colorectal surgery; and the first in patients following an ERAS pathway.

What this paper adds: 244 patients were randomised to the two different supplements. Both groups followed a comprehensive ERAS programme and all other aspects of perioperative care were the same. Overall post-op complications were reduced in the immunonutrition group [23% vs 35%, p=0.035]; but in particular postoperative infectious complications [10.7% vs 23.8%, p=0.007]. This paper strengthens the evidence base for the use of immunonutrition as part of an ERAS pathway.

Chris Jones, Guildford.  @chrisnjones