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Enteral Diet Enriched with ω-3 Fatty Acid Improves Oxygenation After Thoracic Esophagectomy for Cancer: A Randomized Controlled Trial

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Abstract

Background

Although the anti-inflammatory effects of immunomodulating diets (IMDs) have recently attracted attention, the efficacy of enteral feeding of such diets after radical surgery remains controversial. Thus, we conducted a new prospective, randomized controlled study to elucidate any beneficial effect of an IMD containing eicosapentaenoic acid (EPA) and γ-linolenic acid (GLA) in patients undergoing radical esophagectomy for thoracic esophageal cancer.

Methods

From November 2009 to July 2011, 87 consecutive patients were randomized to receive either an IMD enriched with EPA, GLA, and antioxidants (n = 42) or a standard isocaloric, isonitrogenous diet (control group, n = 45) after esophagectomy with radical lymphadenectomy. The primary outcome measure was changes in the oxygenation status (PaO2/FIO2 ratio), and the secondary outcome measures were body composition, inflammation-related factors, coagulation markers, cholesterol concentrations, and major clinical outcomes.

Results

Oxygenation was significantly better on postoperative days (PODs) 4, 6, and 8 in the IMD than control group (366.5 ± 63.3 vs. 317.3 ± 58.8, P = 0.001; 361.5 ± 52.6 vs. 314.0 ± 53.2, P < 0.001; 365.4 ± 71.2 vs. 315.2 ± 56.9, P = 0.001, respectively). Changes in the ratio of body weight on PODs 14 and 21 and lean body weight on POD 21 were significantly greater in the IMD than control group. No significant differences were observed in other measures.

Conclusions

An enteral IMD enriched with EPA and GLA improved oxygenation and maintained the body composition of patients undergoing radical esophagectomy, indicating the potential efficacy of such a diet after esophagectomy.

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Acknowledgements

This trial was supported by Grants-in-Aid for scientific research from the Japan Society for Parenteral and Enteral Nutrition. The authors appreciate the Second Surgical Department of the Osaka City University Hospital for their cooperation during the study. Particularly, they thank K. Mori, M. Okawa, Y. Niwa, R. Hashiba, K. Gyobu, and S. Shinjo for help with patient recruitment and data collection and E. Edagawa for patient randomization. They also thank Y. Nakamura and G. Oka for their excellent work in the assessment and analysis of body composition.

Funding

The authors were personally salaried by their institutions during the period of writing. The funding source had no role in the study design, data collection, data interpretation, data analysis, or writing of the report.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Yasunori Matsuda, Sigeru Lee, Satoru Kishida & Harushi Osugi

  2. Faculty of Human Life Science, Graduate School of Human Life Science, Osaka City University, Osaka, Japan

    Daiki Habu

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  1. Yasunori Matsuda
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  2. Daiki Habu
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  5. Harushi Osugi
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Correspondence to Yasunori Matsuda.

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The authors declare that they have no conflicts of interest.

Additional information

UMIN clinical trials registry—UMIN000002659.

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Matsuda, Y., Habu, D., Lee, S. et al. Enteral Diet Enriched with ω-3 Fatty Acid Improves Oxygenation After Thoracic Esophagectomy for Cancer: A Randomized Controlled Trial. World J Surg 41, 1584–1594 (2017). https://doi.org/10.1007/s00268-017-3893-y

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  • DOI: https://doi.org/10.1007/s00268-017-3893-y

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