title: Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer.
abstract: BACKGROUND
  Perioperative enteral immunonutrition is thought to reduce postoperative morbidity in patients undergoing major gastrointestinal surgery. This study assessed the clinical effects of preoperative enteral immunonutrition in well nourished patients with gastric cancer undergoing total gastrectomy.
  
  
  METHODS
  Well nourished patients with primary gastric cancer, fit for total gastrectomy, were randomized to either a control group with regular diet, or an immunonutrition group that received regular diet supplemented with 1000 ml/day of immunonutrients for 5 consecutive days before surgery. The primary endpoint was the incidence of surgical-site infection (SSI). Secondary endpoints were rates of infectious complications, overall postoperative morbidity and C-reactive protein (CRP) levels on 3-4 days after surgery.
  
  
  RESULTS
  Of 244 randomized patients, 117 were allocated to the control group and 127 received immunonutrition. SSIs occurred in 27 patients in the immunonutrition group and 23 patients in the control group (risk ratio (RR) 1.09, 95 per cent confidence interval 0.66 to 1.78). Infectious complications were observed in 30 patients in the immunonutrition group and 27 in the control group (RR 1.11, 0.59 to 2.08). The overall postoperative morbidity rate was 30.8 and 26.1 per cent respectively (RR 1.18, 0.78 to 1.78). The median CRP value was 11.8 mg/dl in the immunonutrition group and 9.2 mg/dl in the control group (P = 0.113).
  
  
  CONCLUSIONS
  Five-day preoperative enteral immunonutrition failed to demonstrate any clear advantage in terms of early clinical outcomes or modification of the systemic acute-phase response in well nourished patients with gastric cancer undergoing elective total gastrectomy.
  
  
  BACKGROUND
  ID 000000648 (University Hospital Medical Information Network (UMIN) database).
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Fujitani
authors.forename: T
authors.initials: T
authors.lastname: Tsujinaka
authors.forename: J
authors.initials: J
authors.lastname: Fujita
authors.forename: I
authors.initials: I
authors.lastname: Miyashiro
authors.forename: H
authors.initials: H
authors.lastname: Imamura
authors.forename: Y
authors.initials: Y
authors.lastname: Kimura
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: T
authors.initials: T
authors.lastname: Shimokawa
authors.forename: H
authors.initials: H
authors.lastname: Furukawa
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003131:Combined Modality Therapy / Q000379:methods; D017558:Elective Surgical Procedures / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000628:therapy*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein