Abstract
Background. Previous trials showed that perioperative immunonutrition improved outcome in patients
with gastrointestinal cancer. This study was designed to appraise the impact of the
simple preoperative oral arginine and n-3 fatty acids supplementation on immune response,
gut oxygenation, and postoperative infections. Methods. Two hundred patients with colorectal neoplasm were randomized to: (a) oral intake
for 5 days before surgery of a formula enriched with arginine and n-3 fatty acids
(pre-op group; n = 50); (b) same preoperative treatment prolonged after surgery by
jejunal infusion (peri-op group; n = 50); (c) oral intake for 5 days before surgery
of a standard isoenergetic, isonitrogenous formula (control group; n = 50); and (d)
no supplementation before and after operation (conventional group; n = 50). The immune
response was measured by phagocytosis ability of polymorphonuclear cells and delayed
hypersensitivity response to skin tests. Gut oxygenation and microperfusion were assessed
by polarographic probes and laser Doppler flowmetry, respectively. Results. The 4 groups were comparable for demographics, comorbidity, and surgical variables.
The 2 groups receiving immunoutrients (pre-op and peri-op) had a significantly better
immune response, gut oxygenation, and microperfusion than the other 2 groups. Intent-to-treat
analysis showed an overall infection rate of 12% in pre-op, 10% in peri-op, 32% in
control, and 30% in conventional groups (P <.04 pre-op and peri-op vs control and conventional). Conclusion. Preoperative oral arginine and n-fatty acids improves the immunometabolic response
and decreases the infection rate. Postoperative prolongation with such supplemented
formula has no additional benefit. (Surgery 2002;132:805-14.)
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References
- The role of cytokines in the catabolic consequences of infection and injury.JPEN J Parenter Enteral Nutr. 1998; 22: 156-166
- Immune dysfunction in trauma.Surg Clin North Am. 1999; 79: 1385-1416
- Effect of critical illness and nutritional support on mucosal mass and function.Clin Nutr. 1998; 17: 99-105
- The gut: a central organ after surgical stress.Surgery. 1988; 104: 917-923
- Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared to total parenteral nutrition.Crit Care Med. 2001; 29: 200-207
- Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicenter trial.Lancet. 2001; 358: 1487-1492
- Enteral versus parenteral feeding: effect on septic morbidity after blunt and penetrating trauma.Ann Surg. 1992; 215: 503-513
- Nutritional support in clinical practice: review of the published data and recommendation for future directions.JPEN J Parenter Enteral Nutr. 1997; 21: 133-156
- Early postoperative enteral nutrition with arginine, omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact.Crit Care Med. 1995; 23: 652-659
- Modulation of postoperative immune response by enteral nutrition with a diet enriched with arginine, RNA, and omega-3 fatty acids in patients with upper gastrointestinal cancer.Eur J Surg. 1995; 161: 115-122
- Glutamine.Br J Surg. 1996; 83: 305-312
- Immune and nutritional effects of early enteral nutrition after major abdominal operations.Eur J Surg. 1996; 162: 105-112
- Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic and clinical outcome.Surgery. 1992; 112: 56-67
- Glutamine and the prevention of gut integrity.Lancet. 1993; 341: 1363-1365
- Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blind phase 3 trial.Arch Surg. 1999; 134: 428-433
- Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study.Arch Surg. 1999; 134: 1309-1316
- Health care resources consumed to treat postoperative infections: cost saving by perioperative immunonutrition.Shock. 2000; 14: 325-330
- Perioperative nutrition in cancer patients.Nutr Clin Metabol. 2001; 15: 298-307
- Gut function, immune and inflammatory responses in patients perioperatively fed with supplemented formulas.Arch Surg. 1996; 131: 1257-1265
- Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasm.Arch Surg. 1997; 132: 1222-1230
- Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak.Dis Colon Rectum. 2000; 43: 76-82
- Measurement of colonic blood flow with laser Doppler flowmetry.Scand J Gastroenterol. 1986; 21: 871-880
- The CONSORT statement: revised recommendations for improving the quality of reports of parallel-randomised trials.Lancet. 2001; 357: 1191-1194
- A prospective randomized double blind clinical trial of enteral immunonutrition in the critically ill.Crit Care Med. 1998; 26: 1164-1172
- Artificial nutrition after pancreaticoduodenectomy.Pancreas. 2000; 21: 344-351
- Immune and metabolic effects of arginine in surgical patients.Ann Surg. 1988; 208: 512-523
- Arginine stimulates wound healing and immune function in elderly human beings.Surgery. 1993; 114: 155-160
- Arginine-supplemented diets improve survival in gut-derived sepsis and peritonitis by modulating bacterial clearance: the role of nitric oxide.Ann Surg. 1993; 217: 644-654
- The L-arginine-nitric oxide pathway.N Engl J Med. 1993; 329: 2002-2012
- Sepsis and its complications: the clinical problem.Crit Care Med. 1994; 22: 8-11
- Dietary polyunsaturated fatty acids and eicosanoids: potential effect on the modulation of inflammatory and immune cells: an overview.Nutrition. 1990; 6: 24-44
- The effect of parenteral fish oil on leukocyte membrane fatty acids composition and leukotriene-synthetizing capacity in patients with postoperative trauma.Metabolism. 1996; 45: 1208-1213
- Effect of a fish oil structured lipid-based diet on prostaglandin release from mononuclear cells in cancer patients after surgery.JPEN J Parenter Enteral Nutr. 1997; 21: 226-274
- Early enteral feeding in postsurgical cancer patients. Fish oil lipid-based polymeric formula versus a standard polymeric formula.Ann Surg. 1996; 223: 316-333
- Feeding the gut early after digestive surgery: results of a nine-year experience.Clin Nutr. 2002; 21: 59-65
- A prospective randomized clinical trial on perioperative feeding with arginine, omega-3 fatty acids, and RNA-enriched enteral diet: effect on host response and nutritional status.JPEN J Parenter Enteral Nutr. 1999; 23: 314-320
- A prospective randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy.Ann Surg. 1997; 226: 567-580
- Early postoperative immunonutrition: clinical outcome and cost-comparison analysis in surgical patients.Crit Care Med. 1997; 25: 1489-1496
- Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.Ann Surg. 1997; 226: 369-380
- Preoperative oral supplementation with immunonutrients in cancer patients.JPEN J Parenter Enteral Nutr. 1998; 22: 206-211
- Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients.Am J Clin Nutr. 2001; 73: 323-332
Article info
Publication history
Accepted:
July 16,
2002
Footnotes
*Reprint requests: Marco Braga, MD, Department of Surgery, San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
