Preoperative Immunonutrition Suppresses Perioperative Inflammatory Response in Patients with Major Abdominal Surgery—A Randomized Controlled Pilot Study

Author： Giger Urs

Publisher： Springer Publishing Company

ISSN： 1068-9265

Source： Annals of Surgical Oncology, Vol.14, Iss.10, 2007-10, pp. : 2798-2806

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Abstract

Perioperative administration of immunoenriched diets attenuates the perioperative inflammatory response and reduces postoperative infection complications. However, many questions still remain unresolved in this area, such as the length of diet administration, diet composition, and the mechanisms involved. We performed an open, randomized, triple-arm study comparing the effect of two perioperative feeding regimens with a postoperative one. 46 candidates for major elective surgery for malignancy in the upper gastrointestinal tract were randomized to drink preoperatively either 1 L of an immunoenriched formula (Impact) for 5 days (IEF group) or 1 L of Impact plus (Impact enriched with glycine) for 2 days (IEF plus group). The same product as the patient received preoperatively was given to both groups for 7 days postoperatively. In the control group (CON group), patients only received Impact for 7 days postoperatively; there was no preoperative treatment. The main outcome measures were postoperative C-reactive protein (CRP) serum levels. In the two preoperatively supplemented groups (treatment groups), perioperative endotoxin levels, CRP (postoperative day 7), and TNF-α (postoperative days 1 and 3) levels were significantly lower compared to the CON group (p</i> < .01).="" furthermore,="" the="" length="" of="" postoperative="" imu/icu="" stay="" (impact="" 1.9="" ±="" 1.3="" days;="" impact="" plus="" 2.2="" ±="" 1.1="" days;="" control="" group="" 5.9="" ±="" 0.8="" days)="" and="" length="" of="" hospital="" stay="" (impact="" 19.7="" ±="" 2.3="" days;="" impact="" plus="" 20.1="" ±="" 1.3="" days;="" control="" group="" 29.1="" ±="" 3.6="" days)="" were="" both="" reduced="" in="" the="" treatment="" groups="" compared="" to="" the="" control="" group.="" infectious="" complications="" (impact="" 2/14="" (14%);="" impact="" plus="" 5/17="" (29%);="" control="" group="" 10/15="" (67%))="" also="" showed="" a="" trend="" toward="" reduction="" in="" the="" treatment=""> Perioperative administration of an immunoenriched diet significantly reduces systemic perioperative inflammation and postoperative complications in patients undergoing major abdominal cancer surgery, when compared with postoperative diet administration alone. A shortened preoperative feeding regimen of 2 days with Impact enriched with glycine (Impact plus) was as effective as Impact administered for 5 days preoperatively.