Impact of immunonutrition on inflammatory and nutritional biomarkers in perioperative HIPEC patients
DOI:
https://doi.org/10.66154/nmetj.v2i1.19Keywords:
Immunonutrition, HIPEC, Inflammation, Albumin, C-reactive proteinAbstract
Objective: To evaluate C-reactive protein (CRP) and albumin behavior in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) receiving immunonutrition.
Methods: Retrospective observational cohort of nine patients with peritoneal carcinomatosis (2021–2024). Biomarkers were assessed at five perioperative time points. Normality was tested using Shapiro-Wilk. Spearman correlation and nonparametric tests were applied.
Results: CRP peaked 48h after HIPEC, while albumin decreased during the same period. Preoperative CRP variation showed positive correlation with complications (R²=0.542; p=0.156). Discharge BMI correlated negatively with complications (r=-0.66).
Conclusion: HIPEC induces severe metabolic stress reflected by inflammatory and nutritional biomarkers. Dynamic monitoring of these markers may support early identification of patients at higher risk of postoperative complications.
References
McQuade C, Renton M, Chouhan A, et al. Review of imaging peritoneal disease and treatment. Can Assoc Radiol J. 2024;0(0):08465371241296778. doi: https://doi.org/10.1177/08465371241296778
Torres EM. Peritoneal tumors of Mullerian origin: a case report and review of the literature. Int J Med Sci Clin Res Stud. 2022;2(11):1598-1601. doi: https://doi.org/10.47191/ijmscrs/v2-i11-16
Cortés-Guiral D, Cascales-Campos PA, Sugarbaker PH, et al. Primary and metastatic peritoneal surface malignancies. Nat Rev Dis Primers. 2021;7(1):50. doi: https://doi.org/10.1038/s41572-021-00326-6
Sarvestani AL. Malignant peritoneal mesothelioma literature review: past, present, and future. Diagnostic and Interventional Research. 2022;2(4):30. doi: https://doi.org/10.21037/dmr-22-19
Rubio-López J, Durán-Martínez M, Moreno-Blázquez A, et al. Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Langenbecks Arch Surg. 2023;408(1):31. doi: https://doi.org/10.1007/s00423-023-02770-2
Valencia-Sola L, Becerra-Bolaños Á, Mateo-Ferragut M, et al. Cytoreductive Surgery (CS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Postoperative Evolution, Adverse Outcomes and Perioperative Risk Factors. Healthcare (Basel). 2025;13(7):808. doi: https://doi.org/10.3390/healthcare13070808
Guven D, Şahin T, Erul E, et al. The association between albumin levels and survival in patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis. Front Mol Biosci. 2022;9:1039121. doi: https://doi.org/10.3389/fmolb.2022.1039121
Adiamah A, Skořepa P, Weimann A, et al. The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis. Ann Surg. 2019;270(2):247-56. doi: https://doi.org/10.1097/SLA.0000000000003256
García-Malpartida K, Aragón-Valera C, Botella-Romero F, et al. Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review. Nutrients. 2023;15(7):1776. doi: https://doi.org/10.3390/nu15071776
Raczyńska A, Leszczyńska T, Skotnicki P, et al. The Impact of Immunomodulatory Components Used in Clinical Nutrition—A Narrative Review. Nutrients. 2025;17(5):752. doi: https://doi.org/10.3390/nu17050752
Tan G, Chia C, Wong J, Ong W, Zhu H, Ong C, Teo M. Randomized controlled trial investigating perioperative immunonutrition for patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2023;30:777-789. doi: https://doi.org/10.1245/s10434-022-12509-w
Thorgersen E, Asvall J, Frøysnes I, Schjalm C, Larsen S, Dueland S, Andersson Y, Fodstad Ø, Mollnes T, Flatmark K. Increased local inflammatory response to MOC31PE immunotoxin after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2021;28:5252-5262. doi: https://doi.org/10.1245/s10434-021-10022-0
Elias D, Glehen O, Gilly F, et al. Carcinose peritoneal de origem digestiva e primitiva. In: Relatório do 110º Congresso da AFC. Paris: Arnette: Wolters Kluwer França; 2008. p. 23-30.
Sugarbaker PH. Procedimentos de peritonectomia. Surg Oncol Clin N Am. 2003;12(4):703-27. doi: https://doi.org/10.1016/S1055-3207(03)00048-6
Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med. 2016 Jul 15;9:229-55. doi: https://doi.org/10.2147/IJGM.S102819
Kim EY, Yim HW, Park CH, Song KY. C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer. Surg Endosc. 2017 Jan;31(1):445-454. doi: https://doi.org/10.1007/s00464-016-5272-4
Adiamah A, Skořepa P, Weimann A, Lobo DN. The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis. Ann Surg. 2019 Aug;270(2):247-256. doi: https://doi.org/10.1097/SLA.0000000000003256
Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, McMillan DC. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012 Dec;19(13):4168-77. doi: https://doi.org/10.1245/s10434-012-2498-9
Guven DC, Sahin TK, Erul E, Rizzo A, Ricci AD, Aksoy S, Yalcin S. The association between albumin levels and survival in patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis. Front Mol Biosci. 2022 Dec 2;9:1039121. doi: https://doi.org/10.3389/fmolb.2022.1039121
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