Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery

Abstract

BackgroundOesophagogastric cancer surgery is immunosuppressive. This may be modulated by omega-3 fatty acids (O-3FAs). The aim of this study was to assess the effect of perioperative O-3FAs on clinical outcome and immune function after oesophagogastric cancer surgery.MethodsPatients undergoing subtotal oesophagectomy and total gastrectomy were recruited and allocated randomly to an O-3FA enteral immunoenhancing diet (IED) or standard enteral nutrition (SEN) for 7 days before and after surgery, or to postoperative supplementation alone (control group). Clinical outcome, fatty acid concentrations, and HLA-DR expression on monocytes and activated T lymphocytes were determined before and after operation.ResultsOf 221 patients recruited, 26 were excluded. Groups (IED, 66; SEN, 63; control, 66) were matched for age, malnutrition and co-morbidity. There were no differences in morbidity (P = 0·646), mortality (P = 1·000) or hospital stay (P = 0·701) between the groups. O-3FA concentrations were higher in the IED group after supplementation (P < 0·001). The ratio of omega-6 fatty acid to O-3FA was 1·9:1, 4·1:1 and 4·8:1 on the day before surgery in the IED, SEN and control groups (P < 0·001). There were no differences between the groups in HLA-DR expression in either monocytes (P = 0·538) or activated T lymphocytes (P = 0·204).ConclusionDespite a significant increase in plasma concentrations of O-3FA, immunonutrition with O-3FA did not affect overall HLA-DR expression on leucocytes or clinical outcome following oesophagogastric cancer surgery. Registration number: ISRCTN43730758 (http://www.controlled-trials.com). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients

“…Moreover, partial preoperative EN support has been verified to facilitate the postoperative gastrointestinal absorption of nutrients by gastric cancer patients, accelerate the recovery of patients, and enhance the overall clinical outcome (15). It is also noted that previous study reported that nutrition support should be limited to gastric cancer patients who severely malnourished (16), the present study did not address in this regard.…”

Impact of being underweight on the long-term outcomes of patients with gastric cancer

“…Several trials have evaluated the effects of different nutrients on the short-term outcomes following various types of gastrointestinal surgery. For example, some studies have shown that perioperative nutrient supplementation significantly reduces the incidence of postoperative complications and length of hospital stay [26,27], whereas others have failed to demonstrate any benefits from nutrient therapy [28,29]. Therefore, whether perioperative nutritional intervention in underweight patients with gastric cancer can improve their long-term outcome remains unclear.…”

Impact of enteral nutrition on postoperative immune function and nutritional status

“…Gastric cancer patients show relatively severe malnutrition, as a result of many factors, including surgical trauma, perioperative diet control, and low calorie intake, as well as from factors related to gastric cancer itself (Sultan et al, 2012). It has been shown previously in studies on enteral nutrition (EN) in the surgical treatment of diseases that early EN plays an important role in postoperative recovery.…”