Preoperative enteral immunonutrition improves postoperative outcome in patients with gastrointestinal cancer

Objectives: The purpose of this study was to evaluate the effect of preoperative immunonutrition pharmaceutics (IMPACT) diet versus standard enteral nutrition (EN) on the nutritional status and immunity of patients with colorectal or gastrointestinal (GI) cancer and to evaluate whether it influences the incidence of postoperative complication. Methods: Sixty patients with GI cancer were randomly divided into 2 groups, immunonutrition (IM) and control diet (CT), each of which was fed with IMPACT and conventional diet, respectively, for 7 days before surgical procedures. Variables of nutritional status and immunity, postoperative complications, infections, and the days of postoperative hospitalization were measured. Results: There were no significant differences in the immunological and nutritional variables between the 2 groups preoperatively. The incidence of postoperative complications was significantly lower and the days of postoperative hospitalization were significantly decreased in the IM group. Serum concentrations of both prealbumin (PALB) and transferrin (TRF) were lower in the IM than in the CT group on postoperative day 3 (P < 0.01). TRF continued to be significantly lower in the CT group than in the IM group between day 4 and day 7. However, PALB was significantly lower than before operation in the IM group on postoperative day 3 and TRF was significantly higher in the IM than the CT group on postoperative day 3 (P < 0.05). Both PALB and TRF were significantly higher in the IM than the CT group on postoperative day 7 (P < 0.05). Postoperative immunoglobulin G (IgG) level in the IM group was higher than that in the CT group (13.35 +/- 2.06 g/l vs. 9.59 +/- 2.23 g/l, P < 0.05). CD4/CD8 ratio was significantly higher in the IM group (2.10 +/- 0.51 vs. 1.62 +/- 0.52, P < 0.05). Conclusions: Preoperative enteral IM in patients with GI cancer improves nutritional status and immunity and decreases the incidence of postoperative complications and infections.