The impact of preoperative micronutrient supplementation in lung surgery. A prospective randomized trial of oral supplementation of combined alpha-ketoglutaric acid and 5-hydroxymethylfurfural.
OBJECTIVE
Preoperative micronutrient supplementation in fast-track surgery programs have shown to reduce complications, shorten recovery, and thereby lower costs. In a prospective randomized study, the metabolic effects of a combination of alpha-ketoglutaric acid (alpha-KG) and 5-hydroxymethylfurfural (5-HMF) were evaluated concerning their impact on improvement of exercise capacity and reduction of oxidative stress in lung surgery.


METHODS
Thirty-two consecutive patients admitted for lung resection due to NSCLC were randomized to the study protocol. All patients received preoperative nutritional guidelines according to general recommendations. In 16 (study group), a supplementation of 7.2g alpha-KG and 720 mg 5-HMF/day (SANOPAL) was administered from days 1 to 10. Spiroergometric evaluation was carried out at baseline and day 10 after micronutrient supplementation. Blood samples for the determination of oxidative stress, i.e. carbonyl proteins (CPs) and isoprostanes (IPs) were taken on at baseline, in the operating room just before resection treatment, and 25 min after single lung ventilation (SLV).


RESULTS
Spiroergometric re-evaluation showed a significant increase of VO2max (p=0.0108) and Watt's (p=0.011) in favor of the study group. Determination of oxidative stress showed a significant reduction of CPs before (p=0.048) and after SLV (p=0.0001) for the study group compared to the control group. The same is true for IPs before (p=0.003) and after SLV (p=0.02). Hospitalization and intensive care unit (ICU) of the study group showed a significant reduction compared to the control group (p=0.03 and p=0.02, respectively).


CONCLUSIONS
Simple oral supplementation using a combination of alpha-KG and 5-HMF of preoperative micronutrition may therefore be one further step in a multimodality approach of fast-track surgery programs also in lung surgery.
Matzi
Veronika
V
Department of Surgery, Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria.
Lindenmann
Joerg
J
Muench
Andreas
A
Greilberger
Joachim
J
Juan
Heinz
H
Wintersteiger
Reinhard
R
Maier
Alfred
A
Smolle-Juettner
Freyja Maria
FM
D000284:Administration, Oral; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005260:Female; D005662:Furaldehyde / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D007656:Ketoglutaric Acids / Q000008:administration & dosage*; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D013510:Pulmonary Surgical Procedures / Q000379:methods*; D012044:Regression Analysis
D007656:Ketoglutaric Acids; D018977:Micronutrients; C008046:5-hydroxymethylfurfural; D005662:Furaldehyde