IMMUNE AND NUTRITIONAL EFFECTS OF EARLY ENTERAL NUTRITION AFTER MAJORABDOMINAL OPERATIONS

Aim: To investigate the effect of early postoperative enteral nutritio n enriched with arginine, RNA and omega-3 fatty acids on immunological and nutritional variables after elective curative operations for gast ric or pancreatic cancer. Design. Randomised controlled trial. Setting : University hospital, Italy. Subjects: 78 Consecutive patients who we re to undergo curative operations for gastric or pancreatic cancer, 60 of whom were suitable for the study. Interventions: Patients were ran domly allocated to three groups (n = 20 each according to the type of postoperative nutritional support: standard enteral diet, the same die t enriched with arginine, RNA, and omega 3 fatty acids or total parent eral nutrition. The daily nutritional goal was 25 kcal (105 kJ)/kg and 0.25 g nitrogen/kg for all patients. Main outcome measures. Serum con centrations of immunoglobulins, albumin, transferrin, prealbumin, reti nol binding protein (REP); cholinesterase activity, weight loss, durat ion of operation, operative blood loss; blood transfusion; delayed hyp ersensitivity responses, number of lymphocyte subsets, phagocytic abil ity of monocytes, number of interleukin-2 (IL-2) plasma receptors, int erleukin-6 (IL-6) plasma concentrations, postoperative infections and sepsis scores. Results: All enterally fed patients but one completed t he nutritional programme. There were significant postoperative reducti ons in both nutritional and immunological variables in all groups. On postoperative days 4 and 8 prealbumin concentration (p < 0.05), REP co ncentration (p < 0.05), delayed hypersensitivity responses (p < 0.05), phagocytic ability of monocytes (p < 0.01) and concentration of IL-2 receptors (p < 0.009) had all recovered more ill the group receiving t he enriched solution. There was no difference in the postoperative inf ection rates among the three groups, but the infections were less seve re in the enriched group (p < 0.005). Conclusion: Early enteral feedin g was well tolerated. Patients who received the enriched solution reco vered both their nutritional and immunological status quicker than tho se in the other two groups.