Efeitos da imunonutrição perioperatória na inflamação pós-operatória e marcadores imunológicos no Câncer de Pâncreas: uma revisão sistemática e meta-análise

Abstract

Pancreatic cancer is one of the most aggressive neoplasms, associated with high mortality rates and significant immune impairment, aggravated by the immunosuppressive tumor microenvironment and systemic inflammation. Immunonutrition, which combines immunomodulatory nutrients such as arginine, omega-3 fatty acids and nucleotides, has emerged as a promising strategy in the perioperative period. This study carried out a systematic review and meta-analysis to assess the impact of immunonutrition on the immune and inflammatory response in pancreatic cancer patients undergoing surgery. Five randomized clinical trials were included, identified in 5 different databases, totaling 157 patients. The meta-analysis indicated a 29% reduction in the risk of infectious complications in the group receiving immunonutrition (RR = 0.71; 95%CI: 0.50-1.02; p = 0.06), although without statistical significance. No relevant impact on IL-1 levels was observed (mean difference = -0.06; 95%CI: -15.58 to 15.47; p = 0.99), with high heterogeneity between studies (I2 = 71%). Isolated studies have reported immunological improvements, such as an increase in the CD4/CD8 ratio and a reduction in inflammatory markers, suggesting potential benefits. However, the variability in nutritional formulations and the small sample size limit the generalizability of the results. We conclude that perioperative immunonutrition is a promising approach, but the current evidence is limited by methodological heterogeneity and risk of bias. Studies of greater methodological rigour and representative samples are needed to standardize formulations and confirm the clinical benefits of this intervention in the management of pancreatic cancer.