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

• DOI: 10.1002/bjs.7799
• Publication Date: 2012-01-11T18:06:33Z
• Authors: J Sultan; S M Griffin; F Di Franco; J A Kirby; B K Shenton; C J Seal; P Davis; Y K S Viswanath; S R Preston; N Hayes
• Keywords: Adult; Male; Esophageal Neoplasms; Monocytes; 03 medical and health sciences; Enteral Nutrition; Postoperative Complications; 0302 clinical medicine; Gastrectomy; Fatty Acids, Omega-6; Fatty Acids, Omega-3; Humans; Aged; Postoperative Care; Analysis of Variance; Fatty Acids; HLA-DR Antigens; Middle Aged; 3. Good health; Esophagectomy; Randomized Clinical Trials; C-Reactive Protein; Dietary Supplements; Female

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).