The effect of perioperative enteral immunonutrition on host immune and inflammatory responses in malnourished gastric cancer surgical patients

Objectives: To evaluate the effect of perioperative immunonutrition (Supportan) on host immune and inflammatory responses in malnourished gastric cancer surgical patients . Methods : This was a prospective , randomized , single blind , controlled trial . 30 malnourished gastric cancer patients were randomized to receive either an enriched enteral diet ,Supportan( n =15) or a control isocaloric standard enteral diet , Nutrison ( n =15) .For 7 days before surgery , the patients received enteral nutrition by continuous pump infusion via a nasogastric tube . Jejunal infusion was started 12 hours after surgery and continued for 7 days . The daily nutritional goal was 125 kJ(30 kcal)/kg . Postoperative immune and inflammatory responses were investigated by lymphocyte subsets , serum levels of immunoglobulins , C reactive protein ( CRP ) ,interleukin 6 ( IL 6 ) and PGE 2 . Prealbumin , transferrin , and albumin were determined as nutritional indicators. Results : There were significant postoperative changes in inflammatory responses , immunological and nutritional variables in both groups . CD4/CD8 ratio and IgA levels in immunonutrition group were higher ( P 0.05 ) than in the standard group on postoperative day ( POD ) 1, 8 . CRP , IL 6 and PGE 2 levels were lower ( P 0.05) in immunonutrition group than in the standard group on POD 1 , 8 . Prealbumin level recovered more ( P 0.05) in the immunonutrition group than in standard group on POD 8. Conclusions : Perioperative administration of immunonutrition (Supportan) in malnourished cancer patients can ameliorate the host defense, controll inflammatory responses and improve nutritional status.