Immunonutrition Improves Outcome After Gastric Cancer Surgery Laurie Barclay, MD June 28, 2002 Preoperative supplementation with oral immunonutrition in gastric cancer patients halved postoperative infections and shortened hospital stays compared with standard care, according to results of a randomized trial reported in the June issue of Gastroenterology. "Preoperative supplementation is as effective as perioperative administration in improving outcome," write Luca Gianotti and colleagues from the University of Milan in Italy. "Both strategies seem superior to the conventional approach." The investigators randomized 305 patients with gastrointestinal cancer and less than 10% preoperative weight loss to three groups. The preoperative group received oral supplementation for five days before surgery with 1 L/day of formula enriched with arginine, omega-3 fatty acids, and RNA. The perioperative group also received postoperative jejunal infusion with the same enriched formula, and the conventional group received no artificial nutrition before or after surgery. The groups were well matched for clinical and surgical characteristics. Based on intention-to-treat analysis, incidence of postoperative infections was 13.7% in the preoperative group, 15.8% in the perioperative group, and 30.4% in the conventional group (P=.006 vs. preoperative; P=.02 vs. perioperative). Length of hospital stay was 11.6±4.7 days in the preoperative group, 12.2±4.1 days in the perioperative group, and 14.0±7.7 days in the conventional group (P=.008 vs. preoperative and P=.03 vs. perioperative). Post-hoc analysis suggested that immunonutrition reduced postoperative infections in normal, overweight, and obese subgroups, although risk of postoperative complications increased with increased body mass index (BMI). "We suggest in the analysis of future nutritional trials that surgical patients be stratified per BMI," the authors write. "This will enable a better evaluation of the risk of postoperative complications and the impact of different treatments." Gastroenterology. 2002;122:1763-1770 Reviewed by Gary D. Vogin, MD Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.