IMMUNONUTRITION IN GASTRIC-CANCER SURGICAL PATIENTS

The aim of this study was to evaluate the potential advantages of peri operative versus postoperative administration of an enteral immune-enh ancing diet on host defense and protein metabolism. Thirty subjects, c andidates for gastrectomy for cancer, were randomly allocated into two groups. The first group (n = 15) received an enteral formula enriched with arginine, omega-3 fatty acids, and RNA 7 d before and 7 d after surgery; the second group (n = 15) received the same diet but only 7 d after surgery. Postoperative immune and inflammatory responses were i nvestigated by phagocytosis ability of polymorphonuclear cells, interl eukin-2 receptors (IL-2R), lymphocyte subsets, interleukin-6 (IL-6), a nd delayed hypersensitivity response (DHR). Prealbumin (PA), retinol b inding protein, albumin, and transferrin were determined as protein sy nthesis indicators. Perioperative immunonutrition prevented the early postoperative impairment of phagocytosis, DHR, total number of lymphoc ytes, and CD4/CD8 ratio (P < 0.05 versus postoperative group). The Il- 2R levels were significantly higher in the perioperative group (P < 0. 05 versus postoperative on postoperative day [POD] 4 and 8). Periopera tive group also showed lower levels of IL-6 (P < 0.05 versus postopera tive on POD 1, 4, and 8) and higher levels of PA (P = 0.04 versus post operative on POD 8). The perioperative administration of immunonutriti on ameliorated the host defense mechanisms, controlled the inflammator y response, and improved the synthesis of short half-life constitutive proteins. (C) Elsevier Science Inc. 1998.