Immunomodulatory enteral nutrition in post-surgical gastrointestinal cancer: Clinical, biochemical and nutritional impacts.

Abstract

BACKGROUND: Evidence shows that most gastrointestinal cancer patients develop malnutrition, which may contribute to immune function depression; inflammatory response disturbance, and stress response exacerbation, making these patients often present bad surgical results such as infections, delayed surgical wound healing, and longer hospital stays. One of the proposed nutritional strategies to combat this situation is immunonutrition, which provides nutrients that modulate the immune system activity and has been associated with better results in critically ill and surgical oncologic patients. However, the results regarding its efficiency are controversial. Thus, this article aims to evaluate the clinical, biochemical, and nutritional effects of enteral immunonutrition in patients submitted to gastrointestinal cancer surgery. METHODS: A randomized nutritional intervention study was developed in a reference hospital for oncological treatment. Gastrointestinal cancer patients undergoing surgical treatment were randomized into two groups: one receiving standard enteral nutrition and the other receiving immunomodulatory enteral nutrition. Baseline, clinical, and nutritional data were collected. Nutritional support was started immediately after surgery when clinically recommended, and its effects on clinical, biochemical, and nutritional markers were assessed. RESULTS: 100 patients were divided into two groups, 50 in each group. It was observed lower frequency in cases of diarrhea and post-surgical complications such as fistula and sepsis, lower gastric residue, and best parameters related to the nutritional status of iron and vitamin B12, a better immune pattern such as a higher number of lymphocytes and less than leukocytes, lower values of inflammatory acute phase proteins and significantly higher Albumin/Globulin ratio in the group receiving immunomodulatory enteral nutrition, suggesting an improvement in the profile of inflammatory markers. CONCLUSIONS: Results suggest that immunomodulatory nutritional support for patients with gastrointestinal tract cancer submitted to surgery may promote a reduction in severe postoperative complications, such as fistula with sepsis and evisceration, and improve markers of immune function and renal efficiency.