Modulation of postoperative immune and inflammatory response by arginine-enhancing enteral nutrition in gastric caner patients

Objective To evaluate the effect of enteral nutrition supplemented with arginine on host immune and inflammatory responses in gastric cancer patients after operation.Methods By using a prospective,randomized,single-blind and controlled trial,96 gastric cancer patients were randomized to receive either an enriched arginine enteral nutrition:Impact,or a control isocaloric standard enteral diet:Nutrison(n=48).The patients received enteral nutrition by continuous pump infusion via a nasogastric tube.Jejunal infusion was started 48?h after surgery and continued for 7 days.All variables were measured before operation and on postoperative day(POD) 1 and 8.The level of protein,immune function,nitrogen balance,infection-related complications,inflammatory responses and hospital stay were compared between the two groups.Results There were significant postoperative changes in inflammatory response and immunological variables in both groups.CD_3,CD_4,IgG,IgA and IgM levels in immunonutrition group were higher(P0.05) than in the standard group on POD 1 and 8.CRP,IL-6,TNFα and PGE_2 levels were lower(P0.05) and hospital stay was shorter in study group than in control group.The level of protein and nitrogen balance had no difference between the two groups.Conclusion It is clearly established in this trial that early postoperative enteral feeding may be accomplished safely in gastric cancer patients after surgery.Supplementation of enteral nutrition with arginine can ameliorate the host immunosuppression and control inflammatory response.