The effect of preoperative immunonutrition on postoperative immune system and cytokine release in the cases undergoing major abdominal surgery

Background and goal

We aimed to investigate the effects of use of preoperative and early postoperative standard and immunonutrient products on immune system and acute inflammatory response in the patients undergoing gastrointestinal malignancy surgery.

Materials and methods

Ninety patients of ASA II-III, were randomly divided into three groups. All patients were started to be given enteral nutrition in 1000 kcal/day in addition to standard oral nutrition on 5 th preoperative day. Enteral nutrition was restarted with 30 kcal/kg/day via nasojejunal tube or jejunostomy at 12 th hours of surgery. Group I patients (n = 30) received isocaloric, isonitrogenic standard oral nutrition (Osmolyte^®, Abbott), Group II patients (n = 30) received oral immunonutrition (Impact^®, Novartis), whereas Group III patients (n = 30) received enteral or oral nutrition (Supportan^®, Fresenius Kabi). Studies of immune function and evaluation of nutritional parameters were made for all patients on 5 th (T₁) and 1 st (T₂) days preoperatively and 1 st (T₃) and 5 th days (T₄) postoperatively. For nutritional assessment; albumin, prealbumin, retinol binding protein (RBP) and transferrin levels were determined. For immunologic assessment; IL-2 and IL-6 levels, IgG, IgM, total lymphocytes, T-lymphocytes, B-lymphocytes were studied. Postoperative complications, ICU and hospital length of stay, duration of antibiotherapy were also compared between groups.

Results and discussion

In all groups nutritional parameters were significantly decreased on T₃ (P < 0.05). Prealbumin and RBP levels (i.e. early stage nutritional parameters) increased in group II on T₄ (P < 0.05). IL-6 and CRP measurements (i.e. predictors of acute systemic inflammatory response), increased significantly in all groups (P < 0.05) but this increase was lower in group II than the others. IL-2 levels (i.e. the cellular component of immune system) increased significantly on T₃ and T₄ in group II (P < 0.05). T-lymphocytes decreased in group I and III on T₃ and T₄. This decrease was not seen group II. The duration of antibiotherapy, ICU and hospital length of stay was significantly longer in group I than the others. The incidence of postoperative infection was less in group II.

Conclusion

Early enteral nutrition with arginin in hypercatabolic state after major operations results a decrease in severity of acute inflammatory reaction, augmentation in cellular immunologic support, and a decrease in ICU and hospital length of stays.