Clinical Significance of Perioperative Immunonutrition for Patients with Esophageal Cancer

• Published in: World journal of surgery 2007-11, Vol.31 (11), p.2160-2167
• Main Authors: Takeuchi, Hiroya, Ikeuchi, Shunji, Kawaguchi, Yoshiki, Kitagawa, Yuko, Isobe, Yoh, Kubochi, Kiyoshi, Kitajima, Masaki, Matsumoto, Sumio
• Format: Article
• Language: English
• Subjects: Aged; Arginine - administration & dosage; Biological and medical sciences; Carcinoma, Squamous Cell - immunology; Carcinoma, Squamous Cell - surgery; Enteral Nutrition; Esophageal Neoplasms - immunology; Esophageal Neoplasms - surgery; Esophageal Squamous Cell Carcinoma; Esophageal Squamous Cell Carcinoma Patient; Esophagectomy - adverse effects; Esophagus; Fatty Acids, Omega-3 - administration & dosage; Female; Food, Formulated; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Lymphocyte Count; Male; Medical sciences; Middle Aged; Perioperative Care; Postoperative Complications - epidemiology; Surgical Wound Infection - prevention & control; Systemic Inflammatory Response Syndrome; Transthoracic Esophagectomy; Tumors
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-007-9219-8

Background We hypothesized that preoperative and/or postoperative enteral immune‐enhanced formulas that are supplemented with arginine, omega‐3 fatty acids, and RNA may reduce postoperative complications in patients undergoing esophagectomy for thoracic esophageal squamous cell carcinoma (ESCC). Methods Forty patients who underwent esophagectomy were divided into three groups: group A (n = 20) received a control enteral diet (Erental) through the jejunostomy after surgery. group B (n = 6) received an enteral diet supplemented with immune‐enhancing substrates (Impact) containing arginine, omega‐3 fatty acids, and RNA after surgery. group C (n = 14) received the impact before and after surgery. Results Lymphocyte counts in group C on postoperative day (POD) 7 were somewhat higher than that in group A (p = 0.07) and significantly higher than in group B (p = 0.03). Furthermore the incidence of incisional wound infection in group C was significantly lower than that in group A (p = 0.03). Moreover, the duration of postoperative systemic inflammatory response syndrome (SIRS) was significantly shorter in group C than in group A (p < 0.05). Conclusions This study reveals that the perioperative immune‐enhanced formula may be superior to postoperative control enteral formulas in terms of reducing surgical wound infection and postoperative SIRS, which may result in serious postoperative complications for patients who have undergone esophagectomy.