Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2023; 15(11): 2596-2618
Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2596
Effect of perioperative branched chain amino acids supplementation in liver cancer patients undergoing surgical intervention: A systematic review
Kwan Yi Yap, HongHui Chi, Sherryl Ng, Doris HL Ng, Vishal G Shelat
Kwan Yi Yap, HongHui Chi, Sherryl Ng, Vishal G Shelat, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Doris HL Ng, Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Doris HL Ng, Vishal G Shelat, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Co-first authors: Kwan Yi Yap and HongHui Chi.
Author contributions: Yap KY acquisition of data, analysis and interpretation of data, drafting the article, revising the article, final approval; Chi H acquisition of data, analysis and interpretation of data, drafting the article, revising the article, final approval; Ng S acquisition of data, interpretation of data, final approval; Ng DH revising the article; Shelat VG supervision, critical revision, final approval. Yap KY and Chi H contributed equally to this work as co-first authors. This research is the product of the collaborative effort of the team, and the designation of co-first authors authorship is reflective of the time and effort invested by the co-first authors into the completion of the research. Furthermore, the decision of co-first authors authorship acknowledges and respects the equal contribution made by both co-first authors throughout the process of writing the paper. As a whole, the team believes that designating Yap KY and Chi H as co-first authors is appropriate and reflective of the team’s collective spirit and wishes.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vishal G Shelat, DNB, FICS, FRCS (Gen Surg), MBBS, MMed, MNAMS, MS, Associate Professor, Director, Surgical Oncologist, Department of General Surgery, Tan Tock Seng Hospital, No. 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Received: July 31, 2023
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
Abstract
BACKGROUND

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.

AIM

To evaluate the efficacy of perioperative BCAA supplementation in patients undergoing surgery for liver cancer.

METHODS

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.

RESULTS

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.

CONCLUSION

Perioperative BCAA administration is efficacious in reducing postoperative infection, ascites, LOS, and increases body weight in liver cancer patients undergoing surgical resection.

Keywords: Branched-chain amino acid; Liver cancer; Liver surgery; Nutritional supplement; Perioperative supplementation

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.