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World J Gastroenterol. Apr 21, 2008; 14(15): 2434-2439
Published online Apr 21, 2008. doi: 10.3748/wjg.14.2434
Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients
Bin Liang, Shan Wang, Ying-Jiang Ye, Xiao-Dong Yang, You-Li Wang, Jun Qu, Qi-Wei Xie, Mu-Jun Yin
Bin Liang, Shan Wang, Ying-Jiang Ye, Xiao-Dong Yang, You-Li Wang, Jun Qu, Qi-Wei Xie, Mu-Jun Yin, Division of Surgical Oncology and Division of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China
Author contributions: Liang B and Wang S contributed equally to this work; Liang B and Wang S designed the research; Liang B, Ye YJ, Yang XD, Wang YL, Qu J, Xie QW, Yin MJ performed the research and collected the data; Wang S and Ye YJ supervised the research; Liang B and Ye YJ analyzed the data; Liang B wrote the paper and revised the manuscript.
Correspondence to: Shan Wang, Professor, Division of Gas-troenterological Surgery, Peking University People’s Hospital, Beijing 100044, China. dr.wangshan@yahoo.com.cn
Telephone: +86-10-88326806
Fax: +86-10-88326808
Received: November 10, 2007
Revised: January 30, 2008
Published online: April 21, 2008
Abstract

AIM: To investigate the effect of omega-3 fatty acid parenteral supplementation postoperatively on clinical outcomes and immunomodulation in colorectal cancer patients.

METHODS: Forty-two patients undergoing radical colorectal cancer resection with an indication for total parenteral nutrition postoperatively were enrolled in this prospective, double-blind, randomized, controlled study. Patients received total parenteral nutrition supplemented with either soybean oil (LCT; Intralipid®, Fresenius-Kabi, SO group, n = 21) or a combination of omega-3 fish oil and soybean oil (LCT:fish oil = 5:1, fish oil; Omegaven®, Fresenius-Kabi, FO group, n = 21), up to a total of 1.2 g lipid/kg per day for 7 d postoperatively. A same volume calorie and nitrogen was administrated. Routine blood test, biochemistry, systemic levels of IL-6 and TNF-α, percentage of CD3+, CD4+, and CD8+ lymphocytes were evaluated preoperatively and on postoperative d 1 and 8. Patient outcome was evaluated considering mortality during the hospital stay, length of postoperative hospital stay, and occurrence of infectious complications.

RESULTS: Both lipid regimens were well tolerated. No differences between the two groups were noticed in demographics, baseline blood test, biochemistry, serum levels of IL-6 and TNF-α, percentage of CD4+, CD8+ lymphocytes, and ratios of CD4+/CD8+. Compared with those on postoperative d 1, serum IL-6 levels on postoperative d 8 were significantly depressed in the FO group than in the reference group (-44.43 ± 30.53 vs -8.39 ± 69.08, P = 0.039). Simultaneously, the ratios of CD4+/CD8+ were significantly increased in the FO group (0.92 ± 0.62 vs 0.25 ± 1.22, P = 0.035). In addition, depression of serum TNF-α levels (-0.82 ± 2.71 vs 0.27 ± 1.67, P = 0.125) and elevation of CD3+ and CD4+ lymphocyte percentage (12.85 ± 11.61 vs 3.84 ± 19.62, P = 0.081, 17.80 ± 10.86 vs 9.66 ± 17.55, P = 0.084, respectively) were higher in the FO group than in the reference group. Patients in the FO group trended to need a shorter postoperative hospital stay (17.45 ± 4.80 d vs 19.62 ± 5.59 d, P = 0.19). No statistically significant difference was found when stratified to mortality and occurrence of infectious complications.

CONCLUSION: Postoperative supplementation of omega-3 fatty acids may have a favorable effect on the outcomes in colorectal cancer patients undergoing radical resection by lowering the magnitude of inflammatory responses and modulating the immune response.

Keywords: Colorectal cancer; Parenteral nutrition; Omega-3 fatty acids; Immunomodulation; Abdominal surgery