Optimal Nutrition Formulas for Patients Undergoing Surgery for Colorectal Cancer: A Bayesian Network Analysis

Figures & data

Figure 1. Flow chart of articles screening.

Figure 2. Network of indirect comparisons. The size of the nodes stands for the number of patients included and line width the number of articles comparing each pair of articles.

Table 1. Characteristics of the included studies.

Study	Country	Design	Mean Age	Drop out	Nutrition type	TG			CG (sample size)	Duration of nutrition	BMI	Clinical outcomes
						Treatments (Sample size)	Nutrition product
Aliyazicioglu 2013	Turkey	RCT	NR	NR	PN	Glutamine v N-3 PUFAs (8v8)		Dipeptiven omegaven	Standard nutrition (10)	Post-op 5 days	25.64 ± 3.72	LOS
Braga 2002	Italy	RCT	61.88 ± 10.02	0/0	EN	Arginine-based IM (100)		Impact	Standard nutrition (100)	Pre-op 5 days or peri-op	NR	LOS, IC, NIC, AL
Carmen 2016	Spain	RCT	69.90 ± 11.00	0/0	EN	Arginine-based IM (42)		Impact	Standard diet (42)	Pre-op 8 days	NR	LOS. IC, AL
Finco 2006	Italy	RCT	61.70 ± 11.90	0/0	EN	Arginine-based IM (14)		Impact	Standard diet (14)	Pre-op 6 days and post-op 3 days	26.90 ± 3.80	LOS. IC, AL
Horie 2006	Japen	RCT	65.96 ± 10.44	NR	EN	Arginine-based IM (33)		Impact	Standard diet (34)	Pre-op 6 days	22.80 ± 3.03	LOS, IC, NIC, AL
Liang 2008	China	RCT	57.54 ± 10.38	0/1	PN	n-3 PUFAs (20)		Omegaven	Standard nutrition (21)	Post-op 7 days	23.66 ± 2.61	LOS, IC
Moya 2016	Spain	RCT	69.00 ± 11.89	6/7	EN	Arginine-based IM (122)		ATEMPERO	Standard nutrition (122)	Pre-op 7 days and post-op 5 days	27.07 ± 7.27	LOS, IC, NIC, AL
Moya 2016	Spain	RCT	68.50 ± 10.22	0/0	EN	Arginine-based IM (61)		ATEMPERO	Standard diet (61)	Pre-op 7 days and post-op 5 days	NR	LOS, IC, NIC, AL
Oguz 2007	Turkey	RCT	54.39 ± 14.75	NR	PN	Glutamine (57)		Dipeptiven	Standard nutrition (52)	Pre-op 5 days and post-op 5 days	22.95 ± 3.64	LOS, IC, NIC, AL
Sorensen 2013	UK	RCT	70.00 ± 10.52	0/0	EN	N-3 PUFAs (74)		Omegaven	Standard nutrition (74)	Pre-op 7 days and post-op 7 days	26.00 ± 5.00	IC, NIC, AL
Zhu 2012	China	RCT	70.29 ± 8.67	0/0	PN	N-3 PUFAs (29)		Omegaven	Standard nutrition (28)	Post-op 8 days	23.05 ± 3.33	LOS, IC,
Morlion 1998	German	RCT	67.61 ± 11.38	0/0	PN	Glutamine (15)		Dipeptiven	Standard nutrition (13)	Post-op 5 days	24.85 ± 3.37	LOS

TG = Treatment group, CG = Control group, EN = Enteral nutrition, PN = Parenteral nutrition, Arginine-based IM = Arginine-based immunonutrition, LOS = Length of stay, IC = Infectious complication, Non-IC = Noninfectious complication, AL = Anastomotic leakage.

Figure 3. Risk of bias graph and risk of bias summary of RCTs.

Table 2. Comparison of different immunonutrtion formulas in length of hospital stays between pairwise meta-analysis and network.

Arginine-based IM	−3.28 (-6.31, −0.45)	−2.88 (-5.96, 0.19)	0.60 (-1.13, 2.31)
3.28 (0.45, 6.31)	Glutamine	0.42 (-2.42, 3.35)	3.91 (1.69, 6.33)
2.88 (-0.19, 5.96)	−0.42 (-3.35, 2.42)	N-3 PUFAs	3.49 (1.00, 5.96)
−0.60 (-2.31, 1.13)	−3.91 (-6.33, −1.69)	−3.49 (-5.96, −1.00)	Standard nutrition

Table 3. Comparison of different immunonutrtion formulas in infectious complication between pairwise meta-analysis and network.

Arginine-based IM	0.56 (0.06, 6.40)	1.14 (0.14, 10.60)	2.32 (1.05, 5.75)
1.79 (0.16, 18.10)	Glutamine	1.99 (0.11, 38.97)	4.10 (0.45, 37.89)
0.88 (0.09, 7.13)	0.50 (0.03, 9.03)	N-3 PUFAs	2.05 (0.28, 15.01)
0.43 (0.17, 0.95)	0.24 (0.03, 2.22)	0.49 (0.07, 3.59)	Standard nutrition

Table 4. Comparison of different immunonutrtion formulas in noninfectious complication between pairwise meta-analysis and network.

Arginine-based IM	0.08 (0.00, 0.99)	1.66 (0.25, 11.62)	1.13 (0.44, 2.86)
11.91 (1.01, 496.87)	Glutamine	19.94 (1.21, 1041.37)	13.33 (1.28, 481.47)
0.60 (0.09, 3.98)	0.05 (0.00, 0.83)	N-3 PUFAs	0.68 (0.12, 3.47)
0.89 (0.35, 2.25)	0.07 (0.00, 0.78)	1.46 (0.29, 8.08)	Standard nutrition

Table 5. Comparison of different immunonutrtion formulas in Anastomotic leakage between pairwise meta-analysis and network.

Arginine-based IM	0.26 (0.01, 3.27)	2.89 (0.47, 20.48)	1.64 (0.71, 3.62)
3.83 (0.31, 112.14)	Glutamine	11.99 (0.65, 411.33)	6.31 (0.57, 153.72)
0.35 (0.05, 2.14)	0.08 (0.00, 1.53)	N-3 PUFAs	0.55 (0.09, 2.88)
0.61 (0.28, 1.41)	0.16 (0.01, 1.75)	1.81 (0.35, 10.90)	Standard nutrition

Figure 4. Ranking of outcomes for the included studies. Odds ratio (OR) and 95% confidence interval (CI) were used to expressed the difference between formulas. First rank indicates lowest probability to prevent occurrence of infectious, noninfectious and anastomotic leak complications. For length of hospitalization, first rank indicates longest stay in hospital.