Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery

Br J Surg. 2012 Mar;99(3):346-55. doi: 10.1002/bjs.7799. Epub 2012 Jan 11.

Abstract

Background: Oesophagogastric cancer surgery is immunosuppressive. This may be modulated by omega-3 fatty acids (O-3FAs). The aim of this study was to assess the effect of perioperative O-3FAs on clinical outcome and immune function after oesophagogastric cancer surgery.

Methods: Patients undergoing subtotal oesophagectomy and total gastrectomy were recruited and allocated randomly to an O-3FA enteral immunoenhancing diet (IED) or standard enteral nutrition (SEN) for 7 days before and after surgery, or to postoperative supplementation alone (control group). Clinical outcome, fatty acid concentrations, and HLA-DR expression on monocytes and activated T lymphocytes were determined before and after operation.

Results: Of 221 patients recruited, 26 were excluded. Groups (IED, 66; SEN, 63; control, 66) were matched for age, malnutrition and co-morbidity. There were no differences in morbidity (P = 0·646), mortality (P = 1·000) or hospital stay (P = 0·701) between the groups. O-3FA concentrations were higher in the IED group after supplementation (P < 0·001). The ratio of omega-6 fatty acid to O-3FA was 1·9:1, 4·1:1 and 4·8:1 on the day before surgery in the IED, SEN and control groups (P < 0·001). There were no differences between the groups in HLA-DR expression in either monocytes (P = 0·538) or activated T lymphocytes (P = 0·204).

Conclusion: Despite a significant increase in plasma concentrations of O-3FA, immunonutrition with O-3FA did not affect overall HLA-DR expression on leucocytes or clinical outcome following oesophagogastric cancer surgery.

Registration number: ISRCTN43730758 (http://www.controlled-trials.com).

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • C-Reactive Protein / metabolism
  • Dietary Supplements
  • Enteral Nutrition / methods*
  • Esophageal Neoplasms / blood
  • Esophageal Neoplasms / immunology
  • Esophageal Neoplasms / surgery*
  • Esophagectomy / methods
  • Fatty Acids / metabolism
  • Fatty Acids, Omega-3 / administration & dosage*
  • Fatty Acids, Omega-3 / metabolism
  • Fatty Acids, Omega-6 / metabolism
  • Female
  • Gastrectomy / methods
  • HLA-DR Antigens / metabolism
  • Humans
  • Male
  • Middle Aged
  • Monocytes / metabolism
  • Postoperative Care / methods
  • Postoperative Complications / etiology
  • Preoperative Care / methods
  • Prospective Studies
  • Stomach Neoplasms / blood
  • Stomach Neoplasms / immunology
  • Stomach Neoplasms / surgery*
  • T-Lymphocytes / metabolism

Substances

  • Fatty Acids
  • Fatty Acids, Omega-3
  • Fatty Acids, Omega-6
  • HLA-DR Antigens
  • C-Reactive Protein

Associated data

  • ISRCTN/ISRCTN43730758