Previous trials have shown that perioperative immunonutrition improves outcome in patients with gastrointestinal cancer.
|The 2 groups receiving immunoutrients showed significantly better immune response, gut oxygenation, and microperfusion.|
In this study, researchers from Italy sought to assess the impact of the simple preoperative oral arginine and n-3 fatty acids supplementation on immune response, gut oxygenation, and postoperative infections.
The team randomized 200 patients with colorectal neoplasm to 1 of 4 treatments:
- Oral intake of a formula enriched with arginine and n-3 fatty acids, for 5 days before surgery (pre-op group)
- The same preoperative treatment, prolonged after surgery by jejunal infusion (peri-op group)
- Oral intake for 5 days before surgery of a standard isoenergetic, isonitrogenous formula (control group)
- No supplementation before and after operation (conventional group).
They measured immune response using phagocytosis ability of polymorphonuclear cells and delayed hypersensitivity response to skin tests.
In addition, gut oxygenation and microperfusion were assessed by polarographic probes and laser Doppler flowmetry, respectively.
The team found that the 4 groups were comparable for demographics, comorbidity, and surgical variables.
However, 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.
Dr Marco Braga's team concluded, "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".