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Immune and nutritional effects of early enteral nutrition after major abdominal operations
M Braga1, A Vignali, L Gianotti
1Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy.
Aim:
To investigate the effect of early postoperative enteral nutrition enriched with arginine, RNA and omega-3 fatty acids on immunological and nutritional variables after elective curative operations for gastric or pancreatic cancer.
Design:
Randomised controlled trial.
Setting:
University hospital, Italy.
Subjects:
78 Consecutive patients who were to undergo curative operations for gastric or pancreatic cancer, 60 of whom were suitable for the study.
Interventions:
Patients were randomly allocated to three groups (n = 20 each) according to the type of postoperative nutritional support: standard enteral diet, the same diet enriched with arginine, RNA, and omega-3 fatty acids or total parenteral nutrition. The daily nutritional goal was 25 kcal (105 kJ)/kg and 0.25 g nitrogen/kg for all patients.
Main Outcome Measures:
Serum concentrations of immunoglobulins, albumin, transferrin, prealbumin, retinol binding protein (RBP); cholinesterase activity, weight loss, duration of operation, operative blood loss; blood transfusion; delayed hypersensitivity responses, number of lymphocyte subsets, phagocytic ability of monocytes, number of interleukin-2 (IL-2) plasma receptors, interleukin-6 (IL-6) plasma concentrations, postoperative infections and sepsis scores.
Results:
All enterally fed patients but one completed the nutritional programme. There were significant postoperative reductions in both nutritional and immunological variables in all groups. On postoperative days 4 and 8 prealbumin concentration (p < 0.05), RBP concentration (p < 0.05), delayed hypersensitivity responses (p < 0.05), phagocytic ability of monocytes (p < 0.01) and concentration of IL-2 receptors (p < 0.009) had all recovered more in the group receiving the enriched solution. There was no difference in the postoperative infection rates among the three groups, but the infections were less severe in the enriched group (p < 0.005).
Conclusion:
Early enteral feeding was well tolerated. Patients who received the enriched solution recovered both their nutritional and immunological status quicker than those in the other two groups.