title: Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery.
abstract: BACKGROUND
  Oesophagogastric cancer surgery is immunosuppressive. This may be modulated by omega-3 fatty acids (O-3FAs). The aim of this study was to assess the effect of perioperative O-3FAs on clinical outcome and immune function after oesophagogastric cancer surgery.
  
  
  METHODS
  Patients undergoing subtotal oesophagectomy and total gastrectomy were recruited and allocated randomly to an O-3FA enteral immunoenhancing diet (IED) or standard enteral nutrition (SEN) for 7 days before and after surgery, or to postoperative supplementation alone (control group). Clinical outcome, fatty acid concentrations, and HLA-DR expression on monocytes and activated T lymphocytes were determined before and after operation.
  
  
  RESULTS
  Of 221 patients recruited, 26 were excluded. Groups (IED, 66; SEN, 63; control, 66) were matched for age, malnutrition and co-morbidity. There were no differences in morbidity (P = 0·646), mortality (P = 1·000) or hospital stay (P = 0·701) between the groups. O-3FA concentrations were higher in the IED group after supplementation (P < 0·001). The ratio of omega-6 fatty acid to O-3FA was 1·9:1, 4·1:1 and 4·8:1 on the day before surgery in the IED, SEN and control groups (P < 0·001). There were no differences between the groups in HLA-DR expression in either monocytes (P = 0·538) or activated T lymphocytes (P = 0·204).
  
  
  CONCLUSIONS
  Despite a significant increase in plasma concentrations of O-3FA, immunonutrition with O-3FA did not affect overall HLA-DR expression on leucocytes or clinical outcome following oesophagogastric cancer surgery.
  
  
  BACKGROUND
  ISRCTN43730758 (http://www.controlled-trials.com).
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Sultan
authors.forename: S M
authors.initials: SM
authors.lastname: Griffin
authors.forename: F
authors.initials: F
authors.lastname: Di Franco
authors.forename: J A
authors.initials: JA
authors.lastname: Kirby
authors.forename: B K
authors.initials: BK
authors.lastname: Shenton
authors.forename: C J
authors.initials: CJ
authors.lastname: Seal
authors.forename: P
authors.initials: P
authors.lastname: Davis
authors.forename: Y K S
authors.initials: YK
authors.lastname: Viswanath
authors.forename: S R
authors.initials: SR
authors.lastname: Preston
authors.forename: N
authors.initials: N
authors.lastname: Hayes
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000379:methods*; D004938:Esophageal Neoplasms / Q000097:blood / Q000276:immunology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005227:Fatty Acids / Q000378:metabolism; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000378:metabolism; D043371:Fatty Acids, Omega-6 / Q000378:metabolism; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000097:blood / Q000276:immunology / Q000601:surgery*; D013601:T-Lymphocytes / Q000378:metabolism
chemical_list: D005227:Fatty Acids; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D006684:HLA-DR Antigens; D002097:C-Reactive Protein