Effects of Preoperative Use of an Immune-Enhancing Diet on Postoperative Complications and Long-Term Outcome: A Randomized Clinical Trial in Colorectal Cancer Surgery in Japanese Patients

Tomoyuki Moriya, Kazuhiko Fukatsu, Chikara Ueno, Yojiro Hashiguchi, Yoshinori Maeshima, Jiro Omata, Koichi Okamoto, Eiji Shinto, Hideki Ueno, Kazuo Hase, Junji Yamamoto

Abstract


Background: Despite recent advances in surgical techniques and perioperative management, postoperative infectious complications remain a problem in surgical patients. We performed a prospective randomized clinical trial to examine the effects of preoperative Immune Enhancing Diets (IEDs) on postoperative complications in Japanese patients who underwent curative colorectal cancer surgery. This study was also designed to evaluate the optimal dose of preoperative IEDs for the patients without malnutrition. Finally, we analyzed recurrence free survival (RFS) and disease-specific survival (DSS) after surgery in patients who did and did not receive IEDs
preoperatively.
Material and Methods: This was a prospective, randomized clinical trial conducted at the Department of Surgery, National Defense Medical College, from October 2002 to October 2005. The 88 patients undergoing colorectal surgery were enrolled and were randomly divided into 3 groups. The high- (High, N=26) and low- (Low, N=31) dose groups received normal food and, respectively, 750ml/day or 250ml/ day of IEDs for 5 days before the operation. The primary endpoint was the rates of surgical site infection (SSI) and non- infectious complications. We also evaluated the RFS and DSS rate, respectively.
Results: The patients were followed for 77±10 months (9-133 months) after surgery. Incisional SSI rates in the IEDs (High and Low) groups were significantly lower than in the Control group. (0%*, 0%* and 17%) (*P<0.01 vs. Control) The incidences of the infections not involving the surgical site (non-SSI) and the lengths of hospital stay were similar among the three groups. No significant differences were observed in RFS or DSS.
Conclusion: In Japanese patients undergoing colorectal cancer surgery, preoperative IEDs significantly reduced the rate of incisional SSI as compared with the control group. Very interestingly, in Japanese patients, preoperative 250ml/day IED intake may be adequate for colorectal cancer patients without malnutrition. However, with regard to the long term outcome, beneficial effects of preoperative IEDs are not evident.


Keywords


immunonutrition, colorectal cancer surgery, SSI, long term outcome an abbreviated running title: Effect of immunoenhancing diet on surgical outcome clinical

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References


[1] Akyol AM, McGregor, J. R., & Galloway, D. J., et al. (1991). Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis., 6, 179-83.

[2] Katoh, H., Yamashita, K., & Wang, G., et al. (2001). Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg., 15(1), 120-9.

[3] Mirnezami, A., Mirnezami, R., & Chandrakumaran, K., et al. (2011). Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg., 253(5), 890-9.

[4] Konishi, T., Watanabe, T., Kishimoto, J., et al. (2006). Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg., 244(5), 758-63.

[5] Bullard, K. M., Trudel, J. L., & Baxter, N. N., et al. (2005). Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum., 48, 438-443.

[6] Smith, R. L., Bohl, J. K., & McElearney, S. T., et al. (2004). Wound infection after elective colorectal resection. Ann Surg., 239, 599-605; discussion 605-607.

[7] Weimann, A., Braga, M., Harsanyi, L., Laviano, A., Ljunggvist, & O., Soeters, P., et al. (2006). ESPEN(European Societyfor Parenteraland EnteralNutrition). ESPEN Guidelineson Enteral Nutrition:surgery including organ transplantation. ClinNutr, 25, 224-244.

[8] Marimuthu, K., Varadhan, K.K., & Ljungqvist, O., et al. (2012). A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery. Ann Surg., 255(6), 1060-8.

[9] Cerantola, Y., Hübner, M., & Grass, F., et al. (2011). Immunonutrition in gastrointestinal surgery. Br J Surg., 98(1), 37-48.

[10]Horie, H., Okada, M., & Kojima, M., et al. (2006). Favorable effects of preoperative enteral immunonutrition on a surgical site infection in patients with colorectal cancer without malnutrition. Surg Today, 36(12), 1063-8. Epub 2006 Dec 25

[11]Hashiguchi, Y., Hase, K., & Ueno, H., et al. (2011). Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg., 98(8), 1171-8.

[12]Hashiguchi, Y., Hase, K., & Ueno, H., et al. (2010). Prognostic significance of the number of lymph nodes examined in colon cancer surgery: clinical application beyond simple measurement. Ann Surg., 251(5), 872-

81.

[13]Horan, T. C., Gaynes, R. P., & Martone, W. J., et al. (1992). CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infections. Am J Infect Control, 20, 271-274.

[14]Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. (1992). Crit Care Med, 20, 864-74.

Shirakawa, H., Kinoshita, T., & Gotohda, N., et al. (2012). Compliance with and effects of preoperative immunonutrition in patients undergoing pancreaticoduodenectomy. J Hepatobil Pancreat Sci., 19(3), 249-58.

[15]Gianotti, L., Braga, M., Nespoli, L., Radaelli, G., Beneduce, A., & Di Carlo, V. (2002). A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology, 122, 1763-70.

[16]Suzuki, D., Furukawa, K., & Kimura, F., et al. (2010). Effects of perioperative immunonutrition on cell-mediated immunity, T helper type 1 (Th1) /Th2 differentiation and Th17 response after pancreaticoduodenectomy. Surgery, 148(3), 573-81.

[17]Waitzberg, D. L., Saito, H., & Plank, L. D., et al. (2006). Postsurgical infections are reduced with specialized nutrition support. World J Surg, 30, 1592–1604.

[18]Braga, M., Gianotti, L., Vignali, A., & Carlo, V. D. (2002). Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery, 132, 805-

14.

[19]Nakamura, M., Iwahashi, M., & Takifuji, K., et al. (2009). Optimal dose of preoperative enteral immunonutrition for patients with esophageal cancer. Surg Today, 39(10), 855-60.

[20]Okuda, N., Ueshima, H., & Okayama, A., et al. (2005). Relation of long chain n-3 polyunsaturated fatty acid intake to serum high density lipoprotein cholesterol among Japanese men in Japan and Japanese-American men in Hawaii: The INTERLIPID study. Atherosclerosis, 178(2), 371-9.

[21]Iso, H., Kobayashi, M., & Ishihara, J., et al. (2006). Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I. Circulation, 113(2), 195-202.

[22]Mirnezami, A. L., Mirnezami, R., & Chandrakumaran, K., et al. (2011). Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg., 253(5), 890-9.

[23]Tsujimoto, H, Ichikura, T., & Ono, S. (2009). Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Ann Surg Oncol., 16(2), 311-8.

[24]Tsujimoto H, Ueno H, & Hashiguchi Y, et al. (2010). Postoperative infections are associated with adverse outcome after resection with curative intent for colorectal cancer. ONCOLOGY LETTERS, 1, 119-125.




DOI: http://dx.doi.org/10.3968/gh.v2i1.5459

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