Skip to main content

Advertisement

SpringerLink
Log in

Preoperative Enteral Immunonutrition Improves Postoperative Outcome in Patients with Gastrointestinal Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to evaluate the effect of preoperative immunonutrition pharmaceutics (IMPACT) diet versus standard enteral nutrition (EN) on the nutritional status and immunity of patients with colorectal or gastrointestinal (GI) cancer and to evaluate whether it influences the incidence of postoperative complication.

Methods

Sixty patients with GI cancer were randomly divided into 2 groups, immunonutrition (IM) and control diet (CT), each of which was fed with IMPACT and conventional diet, respectively, for 7 days before surgical procedures. Variables of nutritional status and immunity, postoperative complications, infections, and the days of postoperative hospitalization were measured.

Results

There were no significant differences in the immunological and nutritional variables between the 2 groups preoperatively. The incidence of postoperative complications was significantly lower and the days of postoperative hospitalization were significantly decreased in the IM group. Serum concentrations of both prealbumin (PALB) and transferrin (TRF) were lower in the IM than in the CT group on postoperative day 3 (P < 0.01). TRF continued to be significantly lower in the CT group than in the IM group between day 4 and day 7. However, PALB was significantly lower than before operation in the IM group on postoperative day 3 and TRF was significantly higher in the IM than the CT group on postoperative day 3 (P < 0.05). Both PALB and TRF were significantly higher in the IM than the CT group on postoperative day 7 (P < 0.05). Postoperative immunoglobulin G (IgG) level in the IM group was higher than that in the CT group (13.35 ± 2.06 g/l vs. 9.59 ± 2.23 g/l, P < 0.05). CD4/CD8 ratio was significantly higher in the IM group (2.10 ± 0.51 vs. 1.62 ± 0.52, P < 0.05).

Conclusions

Preoperative enteral IM in patients with GI cancer improves nutritional status and immunity and decreases the incidence of postoperative complications and infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1.

Similar content being viewed by others

References

  1. Chang HR, Bistrian B. The role of cytokines in the catabolic consequences of infection and injury. JPEN J Parenter Enteral Nutr 1998;22:156–166

    Article  PubMed  CAS  Google Scholar 

  2. Napolitano LM, et al. Immune dysfunction in trauma. Surg Clin North Am 1999;79:1385–1416

    Article  PubMed  CAS  Google Scholar 

  3. Bozzetti F, Braga M, Gianotti L, et al. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicenter trial. Lancet 2001;358:1487–1492

    Article  PubMed  CAS  Google Scholar 

  4. Braga M, et al. Preoperative oral arginine and n−3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery 2002;132(5):805–814

    Article  PubMed  Google Scholar 

  5. Karen CM, Bruce RB. Immunonutrition: problematic or problem solving. Am J Clin Nutr 2003;77:764–770

    Google Scholar 

  6. Farreras N, Artigas V, Cardona D, et al. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr 2005;24(1):55–65

    Article  PubMed  Google Scholar 

  7. Atkinson S, Sieffiert E, Bihari D. A prospective, randomized, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill. Guy’s Hospital Intensive Care Group. Crit Care Med 1998;26:1164–1172

    Article  PubMed  CAS  Google Scholar 

  8. Braga M, Gianotti L, Radaelli G, et al. Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blind phase 3 trial. Arch Surg 1999;134:428–433

    Article  PubMed  CAS  Google Scholar 

  9. Daly JM, Lieberman MD, Goldfine J, et al. 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

    PubMed  CAS  Google Scholar 

  10. Senkal M, Zumtobel V, Bauer KH, et al. 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

    Article  PubMed  CAS  Google Scholar 

  11. Gianotti L, Braga M, Gentilini O, et al. Artificial nutrition after pancreaticoduodenectomy. Pancreas 2000;21:344–351

    Article  PubMed  CAS  Google Scholar 

  12. Van der Hulst RRW, et al. Glutamine and the prevention of gut integrity. Lancet 1993;341:1363–1365

    Article  PubMed  Google Scholar 

  13. Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral feeding: effect on septic morbidity after blunt and penetrating trauma. Ann Surg 1992;215:503–513

    PubMed  CAS  Google Scholar 

  14. Daly JM, Reynolds J, Thom A, et al. Immune and metabolic effects of arginine in the surgical patient. Ann Surg 1988;208:512–523

    PubMed  CAS  Google Scholar 

  15. Billiar TR, Bankey PE, Svingen BA, et al. Fatty acid intake and Kupffer cell function: fish oil alters eicosanoid and monokine production to endotoxin stimulation. Surgery 1988;104(2):343–349

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Zhongshan Hospital, Fudan University Medical Center, Shanghai, 200032, People’s Republic of China

    Jianmin Xu, Yunshi Zhong, Dayong Jing & Zhaohan Wu

Authors
  1. Jianmin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yunshi Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dayong Jing
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhaohan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jianmin Xu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xu, J., Zhong, Y., Jing, D. et al. Preoperative Enteral Immunonutrition Improves Postoperative Outcome in Patients with Gastrointestinal Cancer. World J. Surg. 30, 1284–1289 (2006). https://doi.org/10.1007/s00268-005-0756-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0756-8

Keywords

Search

Navigation