title: Oral preoperative antioxidants in pancreatic surgery: a double-blind, randomized, clinical trial.
abstract: OBJECTIVE
  Oxidative stress due to ischemia/reperfusion injury increases systemic inflammation and impairs immune defenses. Much interest has developed for the administration of antioxidant substrates in surgical patients. The purpose of this study was to perform a pilot evaluation of the impact of a carbohydrate- containing preconditioning oral nutritional supplement (pONS) enriched with glutamine, antioxidants, and green tea extract on postoperative oxidative stress.
  
  
  METHODS
  We performed a double-blind placebo-controlled randomized clinical trial, involving 36 cancer patients undergoing pancreaticoduodenectomy. Patients were randomized to receive either pONS or placebo twice the day before surgery and once 3 hours before surgery. Total endogenous antioxidant capacity (TEAC), plasma levels of vitamin C, vitamin E, selenium, zinc, F2-isoprostanes, and C-reactive protein were measured at baseline and on postoperative day (POD) 1, 3, and 7.
  
  
  RESULTS
  At surgery, the mean gastric residual volume (mL) was 54.2 in the pONS group versus 51.3 in the placebo group (P = NS). On POD 1 plasma levels of vitamin C (P = 0.001), selenium (P = 0.07), and zinc (P = 0.06) were higher in the pONS group compared to placebo. TEAC was improved on POD 1, 3, and 7 in the pONS group compared to placebo (P = 0.01). No difference was found in plasma C-reactive protein levels after surgery in both groups.
  
  
  CONCLUSIONS
  Perioperative pONS administration positively affected plasma vitamin C levels and improved TEAC shortly after surgery, but did not reduce oxidative stress and systemic inflammation markers.
authors: Department of Surgery, San Raffaele University, Milan, Italy. braga.marco@hsr.it
authors: Marco
authors: M
authors: Braga
authors: Massimiliano
authors: M
authors: Bissolati
authors: Simona
authors: S
authors: Rocchetti
authors: Aldo
authors: A
authors: Beneduce
authors: Nicolò
authors: N
authors: Pecorelli
authors: Valerio
authors: V
authors: Di Carlo
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000097:blood; D003138:Common Bile Duct Neoplasms / Q000097:blood / Q000601:surgery; D019587:Dietary Supplements; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects*; D010179:Pancreas / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D011300:Preoperative Care / Q000379:methods; D015427:Reperfusion Injury / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D012643:Selenium / Q000097:blood; D015032:Zinc / Q000097:blood
chemical_list: D000975:Antioxidants; D012643:Selenium; D015032:Zinc; D001205:Ascorbic Acid