Clinical significance of perioperative immunonutrition for patients with esophageal cancer.
BACKGROUND
We hypothesized that preoperative and/or postoperative enteral immune-enhanced formulas that are supplemented with arginine, omega-3 fatty acids, and RNA may reduce postoperative complications in patients undergoing esophagectomy for thoracic esophageal squamous cell carcinoma (ESCC).


METHODS
Forty patients who underwent esophagectomy were divided into three groups: group A (n = 20) received a control enteral diet (Erental) through the jejunostomy after surgery. group B (n = 6) received an enteral diet supplemented with immune-enhancing substrates (Impact) containing arginine, omega-3 fatty acids, and RNA after surgery. group C (n = 14) received the impact before and after surgery.


RESULTS
Lymphocyte counts in group C on postoperative day (POD) 7 were somewhat higher than that in group A (p = 0.07) and significantly higher than in group B (p = 0.03). Furthermore the incidence of incisional wound infection in group C was significantly lower than that in group A (p = 0.03). Moreover, the duration of postoperative systemic inflammatory response syndrome (SIRS) was significantly shorter in group C than in group A (p < 0.05).


CONCLUSIONS
This study reveals that the perioperative immune-enhanced formula may be superior to postoperative control enteral formulas in terms of reducing surgical wound infection and postoperative SIRS, which may result in serious postoperative complications for patients who have undergone esophagectomy.
Takeuchi
Hiroya
H
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. hiroyatakeuchi@aol.com
Ikeuchi
Shunji
S
Kawaguchi
Yoshiki
Y
Kitagawa
Yuko
Y
Isobe
Yoh
Y
Kubochi
Kiyoshi
K
Kitajima
Masaki
M
Matsumoto
Sumio
S
D000368:Aged; D001120:Arginine / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000276:immunology / Q000601:surgery; D004750:Enteral Nutrition; D004938:Esophageal Neoplasms / Q000276:immunology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005526:Food, Formulated; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000517:prevention & control
D015525:Fatty Acids, Omega-3; D001120:Arginine