Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery.
BACKGROUND
Specific immunonutrients may reduce the incidence of postoperative complications and shorten recovery time. This randomized trial evaluated the clinical efficacy of a fish oil emulsion on outcome and immune function after gastrointestinal cancer surgery.


METHODS
A total of 206 patients with gastrointestinal or colonic cancer were randomized to receive isocaloric and isonitrogenous intravenous infusions of either soybean oil alone (1.2 g per kg bodyweight per day; control group, 103 analysed) or soybean plus fish oil emulsion (1.0 and 0.2 g per kg per day respectively; treatment group, 100 analysed) over 20-24 h daily for 7 days after surgery.


RESULTS
Baseline data were comparable in the two groups. There were fewer infectious complications (four versus 12 on day 8; P = 0.066), systemic inflammatory response syndrome (SIRS) was significantly less common (four versus 13; P = 0.039) and hospital stay was significantly shorter (mean(s.d.) 15(5) versus 17(8) days; P = 0.041) in the treatment group. Total postoperative medical costs were comparable in the two groups (mean(s.d.) US $ 1269(254) and 1302(324) in treatment and control groups respectively; P = 0.424). The median (interquartile range) difference in CD4/CD8 between days 1 and 8 after surgery was + 0.30 (0.06 to 0.79) in patients receiving fish oil and + 0.20 (-0.19 to 0.55) in controls (P = 0.021). No severe adverse events occurred in either group.


CONCLUSIONS
Fish oil emulsion-supplemented parenteral nutrition significantly reduced SIRS and length of hospital stay. These clinical benefits may be related to normalization of cellular immune functions and modulation of the inflammatory response.
Jiang
Z M
ZM
Department of Surgery and Parenteral and Enteral Nutrition, and Centre for Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. jiangzm@imicams.ac.cn
Wilmore
D W
DW
Wang
X R
XR
Wei
J M
JM
Zhang
Z T
ZT
Gu
Z Y
ZY
Wang
S
S
Han
S M
SM
Jiang
H
H
Yu
K
K
D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D001835:Body Weight; D016516:CD4-CD8 Ratio; D003110:Colonic Neoplasms / Q000276:immunology / Q000601:surgery; D003362:Cost-Benefit Analysis; D004655:Emulsions; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D005770:Gastrointestinal Neoplasms / Q000276:immunology / Q000601:surgery*; D006801:Humans; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000378:metabolism; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000276:immunology; D012141:Respiratory Tract Infections / Q000209:etiology / Q000276:immunology; D013024:Soybean Oil / Q000008:administration & dosage* / Q000191:economics; D013530:Surgical Wound Infection / Q000209:etiology / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014552:Urinary Tract Infections / Q000209:etiology / Q000276:immunology
D004655:Emulsions; D005395:Fish Oils; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D013024:Soybean Oil