Clinical Effect of Preoperative Administration of Enteral Nutrition Enriched ω-3 Fatty Acids for Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WUYing-xin , XIALin , WANGYong , HUANGYu-qian ,  WUXiao-ting

Department of General Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

WUXiao-ting, Email: wxt1@medmail.com.cn

Keywords：

ω-3 fatty acids; Gastric cancer; Enteral nutrition; Inflammatory reaction; Safety

DOI：

10.7507/1007-9424.20150084

Video：

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Objective To evaluate the safety and efficacy of preoperation administration of enteral nutrition enriched ω-3 fatty acids for gastric cancer patients. Methods A single center randomized controlled clinical trial was performed in 60 cases of gastric cancer in West China Hospital during January 2014 to June 2014, and cases were equally randomized divided into treatment group and control group. Cases of treatment group were given enteral nutrition enriched ω-3 fatty acids which was manufactured by Fresenius Kabi Deutschland GmbH for 5 consecutive days before operation, and cases of control group were given an isocaloric and isonitrogenous homogenized diet for 5 consecutive days before operation. The laboratory indexes of nutritional status and imflammatory factors were observed and compared between 2 groups on admission, preoperative day 1, postoperative day 3, and postoperative day 5. Liver and kidney function indexes which as the safety indexes were detected on admission and preoperative day 1. Vomiting, diarrhea, and infectious complications were recorded in addition. Results On 3 days after operation, levels of interleukin-6 (IL-6) and α-acid glycoprotein (AAG) of treatment group were both lower than those of control group (P<0.05); on 5 days after operation, levels of C-reactive protein (CRP) of treatment group was lower than that of control group too (P<0.05); but at other time points, there were no significant differences in any index between the 2 groups (P>0.05). During the period of enteral nutrition, only 1 case suffered from bloating and 1 case suffered from diarrhea, both in treatment group, and the incidence of adverse reactions didn't differed between treatment group[6.7% (2/30)]and control group[0 (0/30)], P>0.05. Moreover, there were no significant differences between treatment group and control group in incidences of wound infection[3.3% (1/30) vs. 10.0% (3/30)], abdominal infection[0 (0/30) vs. 3.3% (1/30)], urinary infection[0 (0/30) vs. 3.3% (1/30)], and pulmonary infection[0 (0/30) vs. 6.7% (2/30)], but the total incidence of complication was lower in treatment group than that of control group[3.3% (1/30) vs. 23.3% (7/30)], P=0.026. Conclusion Enteral nutrition enriched ω-3 fatty acids can reduce the rate of infection-related complication for patients with gastric cancer, and has a sense of safety.

Citation： WUYing-xin, XIALin, WANGYong, HUANGYu-qian, WUXiao-ting. Clinical Effect of Preoperative Administration of Enteral Nutrition Enriched ω-3 Fatty Acids for Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(3): 312-316. doi: 10.7507/1007-9424.20150084 Copy

1.	Pourhoseingholi MA, Vahedi M, Baghestani AR. Burden of gastrointestinal cancer in Asia; an overview. Gastroenterol Hepatol Bed Bench, 2015, 8(1):19-27.
2.	de Martel C, Forman D, Plummer M. Gastric cancer:epidemiology and risk factors. Gastroenterol Clin North Am, 2013, 42(2):219-240.
3.	Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory:an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol, 2006, 65(4):326-331.
4.	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002):a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3):321-336.
5.	Choi KS, Suh M. Screening for gastric cancer:the usefulness of endoscopy. Clin Endosc, 2014, 47(6):490-496.
6.	Harvey SE, Parrott F, Harrison DA, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med, 2014, 371(18):1673-1684.
7.	Huhmann MB, August DA. Perioperative nutrition support in cancer patients. Nutr Clin Pract, 2012, 27(5):586-592.
8.	Horgan A. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Tech Coloproctol, 2014, 18(11):1137-1138.
9.	Nespoli L, Coppola S, Gianotti L. The role of the enteral route and the composition of feeds in the nutritional support of malnourished surgical patients. Nutrients, 2012, 4(9):1230-1236.
10.	Makay O, Kaya T, Firat O, et al. Omega-3 fatty acids have no impact on serum lactate levels after major gastric cancer surgery. JPEN J Parenter Enteral Nutr, 2011, 35(4):488-492.
11.	Chen B, Zhou Y, Yang P, et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery:a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2010, 34(4):387-394.
12.	Aoyama T, Hayashi T, Fujikawa H, et al. Effect of enteral nutrition enriched with eicosapentaenoic acid on body weight loss and compliance with S-1 adjuvant chemotherapy after gastric cancer surgery. Gan To Kagaku Ryoho, 2013, 40(12):2289-2291.
13.	Wei Z, Wang W, Chen J, et al. A prospective, randomized, controlled study of omega-3 fish oil fat emulsion-based parenteral nutrition for patients following surgical resection of gastric tumors. Nutr J, 2014, 13(1):25-31.
14.	Dali-Youcef N, Mecili M, Ricci R, et al. Metabolic inflammation:connecting obesity and insulin resistance. Ann Med, 2013, 45(3):242-253.
15.	Zhao Y, Wu Y, Pei J, et al. Safety and efficacy of parenteral fish oil-containing lipid emulsions in premature neonates:a meta-analysis of randomized controlled trials. J Pediatr Gastroenterol, 2014,[Epub ahead of print].
16.	Qadri Q, Rasool R, Gulzar GM, et al. H. pylori infection, inflamma-tion and gastric cancer. J Gastrointest Cancer, 2014, 45(2):126-132.
17.	Chan DC, Chen CJ, Chu HC, et al. Evaluation of serum amyloid A as a biomarker for gastric cancer. Ann Surg Oncol, 2007, 14(1):84-93.
18.	Taniguchi K, Karin M. IL-6 and related cytokines as the critical lynchpins between inflammation and cancer. Semin Immunol, 2014, 26(1):54-74.
19.	张翠平, 李小翠, 汤仁仙, 等. p38MAPK抑制剂对小鼠急性移植物抗宿主病的发生及小肠损伤的影响. 中华血液学杂志, 2013, 34(8):673-678.
20.	Chirwa N, Govender D, Ndimba B, et al. A 40-50kDa glycoprotein associated with mucus is identified as alpha-1-acid glycoprotein in carcinoma of the stomach. J Cancer, 2012, 3(1):83-92.
21.	Sasazuki S, Inoue M, Sawada N, et al. Plasma levels of C-reactive protein and serum amyloid A and gastric cancer in a nested case-control study:Japan Public Health Center-based prospective study. Carcinogenesis, 2010, 31(4):712-718.
22.	Cury-Boaventura MF, Gorjão R, de Lima TM, et al. Effect of olive oil-based emulsion on human lymphocyte and neutrophil death. JPEN J Parenter Enteral Nutr, 2008, 32(1):81-87.
23.	Doig GS, Simpson F, Sweetman EA, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition a randomized controlled trial. JAMA, 2013, 309(20):2130-2138.

1. Pourhoseingholi MA, Vahedi M, Baghestani AR. Burden of gastrointestinal cancer in Asia; an overview. Gastroenterol Hepatol Bed Bench, 2015, 8(1):19-27.
2. de Martel C, Forman D, Plummer M. Gastric cancer:epidemiology and risk factors. Gastroenterol Clin North Am, 2013, 42(2):219-240.
3. Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory:an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol, 2006, 65(4):326-331.
4. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002):a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3):321-336.
5. Choi KS, Suh M. Screening for gastric cancer:the usefulness of endoscopy. Clin Endosc, 2014, 47(6):490-496.
6. Harvey SE, Parrott F, Harrison DA, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med, 2014, 371(18):1673-1684.
7. Huhmann MB, August DA. Perioperative nutrition support in cancer patients. Nutr Clin Pract, 2012, 27(5):586-592.
8. Horgan A. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Tech Coloproctol, 2014, 18(11):1137-1138.
9. Nespoli L, Coppola S, Gianotti L. The role of the enteral route and the composition of feeds in the nutritional support of malnourished surgical patients. Nutrients, 2012, 4(9):1230-1236.
10. Makay O, Kaya T, Firat O, et al. Omega-3 fatty acids have no impact on serum lactate levels after major gastric cancer surgery. JPEN J Parenter Enteral Nutr, 2011, 35(4):488-492.
11. Chen B, Zhou Y, Yang P, et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery:a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2010, 34(4):387-394.
12. Aoyama T, Hayashi T, Fujikawa H, et al. Effect of enteral nutrition enriched with eicosapentaenoic acid on body weight loss and compliance with S-1 adjuvant chemotherapy after gastric cancer surgery. Gan To Kagaku Ryoho, 2013, 40(12):2289-2291.
13. Wei Z, Wang W, Chen J, et al. A prospective, randomized, controlled study of omega-3 fish oil fat emulsion-based parenteral nutrition for patients following surgical resection of gastric tumors. Nutr J, 2014, 13(1):25-31.
14. Dali-Youcef N, Mecili M, Ricci R, et al. Metabolic inflammation:connecting obesity and insulin resistance. Ann Med, 2013, 45(3):242-253.
15. Zhao Y, Wu Y, Pei J, et al. Safety and efficacy of parenteral fish oil-containing lipid emulsions in premature neonates:a meta-analysis of randomized controlled trials. J Pediatr Gastroenterol, 2014,[Epub ahead of print].
16. Qadri Q, Rasool R, Gulzar GM, et al. H. pylori infection, inflamma-tion and gastric cancer. J Gastrointest Cancer, 2014, 45(2):126-132.
17. Chan DC, Chen CJ, Chu HC, et al. Evaluation of serum amyloid A as a biomarker for gastric cancer. Ann Surg Oncol, 2007, 14(1):84-93.
18. Taniguchi K, Karin M. IL-6 and related cytokines as the critical lynchpins between inflammation and cancer. Semin Immunol, 2014, 26(1):54-74.
19. 张翠平, 李小翠, 汤仁仙, 等. p38MAPK抑制剂对小鼠急性移植物抗宿主病的发生及小肠损伤的影响. 中华血液学杂志, 2013, 34(8):673-678.
20. Chirwa N, Govender D, Ndimba B, et al. A 40-50kDa glycoprotein associated with mucus is identified as alpha-1-acid glycoprotein in carcinoma of the stomach. J Cancer, 2012, 3(1):83-92.
21. Sasazuki S, Inoue M, Sawada N, et al. Plasma levels of C-reactive protein and serum amyloid A and gastric cancer in a nested case-control study:Japan Public Health Center-based prospective study. Carcinogenesis, 2010, 31(4):712-718.
22. Cury-Boaventura MF, Gorjão R, de Lima TM, et al. Effect of olive oil-based emulsion on human lymphocyte and neutrophil death. JPEN J Parenter Enteral Nutr, 2008, 32(1):81-87.
23. Doig GS, Simpson F, Sweetman EA, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition a randomized controlled trial. JAMA, 2013, 309(20):2130-2138.

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Clinical Effect of Preoperative Administration of Enteral Nutrition Enriched ω-3 Fatty Acids for Gastric Cancer

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