title: The impact of preoperative micronutrient supplementation in lung surgery. A prospective randomized trial of oral supplementation of combined alpha-ketoglutaric acid and 5-hydroxymethylfurfural.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria.
authors.forename: Veronika
authors.initials: V
authors.lastname: Matzi
authors.forename: Joerg
authors.initials: J
authors.lastname: Lindenmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Muench
authors.forename: Joachim
authors.initials: J
authors.lastname: Greilberger
authors.forename: Heinz
authors.initials: H
authors.lastname: Juan
authors.forename: Reinhard
authors.initials: R
authors.lastname: Wintersteiger
authors.forename: Alfred
authors.initials: A
authors.lastname: Maier
authors.forename: Freyja Maria
authors.initials: FM
authors.lastname: Smolle-Juettner
mesh_terms: 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
chemical_list: D007656:Ketoglutaric Acids; D018977:Micronutrients; C008046:5-hydroxymethylfurfural; D005662:Furaldehyde