title: Perioperative Enteral Immunonutrition Modulates Systemic and Mucosal Immunity and the Inflammatory Response in Patients With Periampullary Cancer Scheduled for Pancreaticoduodenectomy: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Nutritional deficiencies and immune dysfunction in cancer patients may contribute to postoperative septic morbidity. This trial compared the effects of perioperative enteral immunonutrition (EIN) versus standard enteral nutrition (SEN) on systemic and mucosal immunity in patients undergoing pancreaticoduodenectomy for periampullary cancer.
  
  
  METHODS
  Thirty-seven patients were randomized (EIN, n = 17; SEN, n = 20) to receive feed for 14 days preoperatively and 7 days postoperatively. Mediators of systemic immunity (interleukin 1α, tumor necrosis factor α, lymphocytes subsets, and complement components) and of mucosal immunity in duodenal biopsies, nutritional markers and parameters were evaluated.
  
  
  RESULTS
  The groups were comparable for demographics, the concentrations of mediators of systemic and mucosal immunity at time of recruitment, and for the duration and amount of feed received. Preoperative EIN rather than SEN was associated with significant reductions in plasma tumor necrosis factor α and total hemolytic complement. Enteral immunonutrition-fed patients had significantly higher total lymphocyte count on the third postoperative day and significantly greater rise in CD4/CD8 ratio from day 3 to day 7 postoperatively compared with SEN-fed patients.
  
  
  CONCLUSIONS
  The perioperative administration of EIN rather than SEN is associated with a favorable modulation of the inflammatory response and enhancement of systemic immunity in patients undergoing pancreaticoduodenectomy for periampullary cancer.
authors.affiliation: From the *Department of Hepato-Pancreato-Biliary Surgery, North Manchester General Hospital; †Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary; ‡Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital; §The University of Manchester; and ∥Department of Laboratory Medicine, The University of Manchester, Manchester, UK.
authors.forename: Numan
authors.initials: N
authors.lastname: Hamza
authors.forename: Ammar
authors.initials: A
authors.lastname: Darwish
authors.forename: Derek A
authors.initials: DA
authors.lastname: O'Reilly
authors.forename: John
authors.initials: J
authors.lastname: Denton
authors.forename: Aali J
authors.initials: AJ
authors.lastname: Sheen
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: David J
authors.initials: DJ
authors.lastname: Sherlock
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000368:Aged; D016516:CD4-CD8 Ratio; D003165:Complement System Proteins / Q000276:immunology; D016207:Cytokines / Q000097:blood / Q000276:immunology; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D004386:Duodenum / Q000276:immunology* / Q000473:pathology; D004739:England; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D018928:Immunity, Mucosal; D016867:Immunocompromised Host; D018836:Inflammation Mediators / Q000097:blood / Q000276:immunology; D007413:Intestinal Mucosa / Q000276:immunology* / Q000473:pathology; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D016577:Pancreaticoduodenectomy; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019139:Tumor Escape
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators; D003165:Complement System Proteins