title: Clinical and immunological impact of early postoperative enteral immunonutrition after total gastrectomy in gastric cancer patients: a prospective randomized study.
abstract: BACKGROUND
  Enteral immunodiet has been gaining increasing attention, but experimental data of its clinical effects in patients with gastric cancer are inconsistent, contradictory, and poorly investigated. The aim of this study was to assess the impact of early postoperative enteral immunonutrition on clinical and immunological outcomes in a homogeneous group of gastric cancer patients submitted to total gastrectomy.
  
  
  METHODS
  A total of 109 patients with gastric cancer were randomized to receive early postoperative enteral immunonutrition (formula supplemented with arginine, omega-3 fatty acids and ribonucleic acid [RNA]), or an isocaloric-isonitrogenous control. The postoperative outcome was evaluated based on clinical variables, including postoperative infectious complications, anastomotic leak rate, and length of hospitalization. In addition, state of cellular immunity was evaluated and compared between the 2 groups.
  
  
  RESULTS
  The incidence of postoperative infectious complications in the immunodiet group (7.4%) was significantly (p < .05) lower than that of the control group (20%), as well as the anastomotic leak rate (3.7% in immunodiet group vs 7.3% in standard nutrition group, p < .05). Mortality rate did not show any significant differences; patients of the immunodiet group were found to have a significantly reduced length of hospitalization (12.7 ± 2.3 days) when compared with standard diet group (15.9 ± 3.4 days, p = .029). The data on cellular immunity showed that the postoperative CD4(+) T-cell counts decreased in both groups, but the reduction in the IED group was significantly higher (p = .032) compared with the SND group.
  
  
  CONCLUSIONS
  Early postoperative enteral immunonutrition significantly improves clinical and immunological outcomes in patients undergoing gastrectomy for gastric cancer.
authors.affiliation: 8th General and Gastrointestinal Surgery-Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine, Second University of Naples, Naples, Italy, marano.luigi@email.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Marano
authors.forename: Raffaele
authors.initials: R
authors.lastname: Porfidia
authors.forename: Modestino
authors.initials: M
authors.lastname: Pezzella
authors.forename: Michele
authors.initials: M
authors.lastname: Grassia
authors.forename: Marianna
authors.initials: M
authors.lastname: Petrillo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.forename: Bartolomeo
authors.initials: B
authors.lastname: Braccio
authors.forename: PierLuigi
authors.initials: P
authors.lastname: Gallo
authors.forename: Virginia
authors.initials: V
authors.lastname: Boccardi
authors.forename: Angelo
authors.initials: A
authors.lastname: Cosenza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Izzo
authors.forename: Natale
authors.initials: N
authors.lastname: Di Martino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005526:Food, Formulated; D005743:Gastrectomy; D006801:Humans; D007167:Immunotherapy; D007239:Infections / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000276:immunology* / Q000601:surgery*; D015996:Survival Rate