Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2596
Peer-review started: July 31, 2023
First decision: September 5, 2023
Revised: September 15, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: November 27, 2023
Processing time: 118 Days and 19.6 Hours
Branched chain amino acid (BCAA) supplementation has been associated with favourable outcomes in liver malignancies requiring definitive resection or liver transplantation. Currently, there are no updated systematic reviews evaluating the efficacy of perioperative BCAA supplementation in patients undergoing surgery for liver cancer.
To evaluate the efficacy of perioperative BCAA supplementation in patients undergoing surgery for liver cancer.
A systematic review of randomized control trials and observational studies was conducted on PubMed, Embase, Cochrane Library, Scopus, and Web of Science to evaluate the effect of perioperative BCAA supplementation compared to standard in-hospital diet, in liver cancer patients undergoing surgery. Clinical outcomes were extracted, and a meta-analysis was performed on relevant outcomes.
16 studies including 1389 patients were included. Perioperative BCAA administration was associated with reduced postoperative infection [risk ratio (RR) = 0.58 95% confidence intervals (CI): 0.39 to 0.84, P = 0.005] and ascites [RR = 0.57 (95%CI: 0.38 to 0.85), P = 0.005]. There was also a reduction in length of hospital stay (LOS) [weighted mean difference (WMD) = -3.03 d (95%CI: -5.49 to -0.57), P = 0.02] and increase in body weight [WMD = 1.98 kg (95%CI: 0.35 to 3.61, P = 0.02]. No significant differences were found in mortality, cancer recurrence and overall survival. No significant safety concerns were identified.
Perioperative BCAA administration is efficacious in reducing postoperative infection, ascites, LOS, and increases body weight in liver cancer patients undergoing surgical resection.
Core Tip: Liver surgery has been associated with anthropometric disturbances and systemic catabolism, which can be improved with perioperative branched chain amino acid (BCAA) supplementation. However, it remains undetermined if the reported advantages of BCAA supplementation warrant routine perioperative use. This systematic review compares sixteen studies including 1389 patients. We found that perioperative BCAA supplementation was efficacious in reducing postoperative infection, ascites, length of hospital stay and increases body weight in liver cancer patients undergoing surgical resection.