D. B. Porter1, K. M. McMasters1, C. R. Scoggins1, R. C. Martin1, M. E. Egger1, P. Philips1 1University Of Louisville,Louisville, KY, USA
Introduction:
Axillary and inguinal lymphadenectomy for melanoma is associated with a high infectious complication rate and lymphedema. There are conflicting data on the efficacy of preoperative immunonutritional supplementation in reducing infectious complication rates mostly after abdominal surgery. The aim of this study is to assess the tolerability and efficacy of preoperative immunonutrition in reducing infectious complications after inguinal and axillary lymphadenectomy.
Methods:
Thirty-nine patients who underwent inguinal/axillary lymphadenectomy for melanoma, between 2014-2017, received 5 days of immunonutritional supplement (3 cans of Impact AR®, Nestle® containing arginine, omega-3 fatty acids, nucleotides) preoperatively and perioperative outcomes were compared with thirty-nine patients from 2011-2017 who did not receive nutritional supplementation from a prospective melanoma database. All patients underwent nutritional assessment using the MUST (Malnutrition Universal Screening Tool) score and malnourished patients (score >1) were excluded from this study. High-grade infectious complications were defined as infections requiring intervention or hospitalization (CTCAE V4.03, Grade 3 or higher).
Results:
Immunonutrition group and control group had similar comorbidities (diabetes: 6 vs. 7, p=0.6572, tobacco use: 15 vs. 15), primary site (truncal 18 vs. 19, extremity 21 vs. 20, p=0.748) and lymphadenectomy site (groin 16, axillary 23 each). Median lymph node yields were similar between both groups for axillary (19, IQR 13, 23.5 vs. 18, IQR 13.5, 23.5, p=0.872) and inguinal lymphadenectomy (15 IQR 10, 21 vs. 15, IQR 11.5, 20, p=0.853). Overall compliance was good with 31 (79.5%) patients completing the 5-day course and 8 (20.5%) completing at least 3 days. Reasons for poor compliance were dislike of the supplement flavor in 5 and bloating in 4. No significant difference was noted between the two groups with respect to postoperative seroma rate, prolonged drainage, length of hospital stay and lymphedema rates. Overall complication rates were similar (19, 48.7% vs. 24, 61.5%, p=0.2513) but the immunonutrition group had a lower total number of patients with infectious complications (7 vs. 14, p=0.0035) and fewer high-grade infections (3 vs. 8, p=0.0027).
Conclusion:
Preoperative immunonutrition with Impact AR® was well tolerated and in well-nourished patients demonstrated a significant decrease in infectious complications. A larger randomized trial is needed to further investigate this finding.
