Matsuda Yasunori, Habu Daiki, Lee Sigeru, Kishida Satoru, Osugi Harushi
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Faculty of Human Life Science, Graduate School of Human Life Science, Osaka City University, Osaka, Japan.
World J Surg. 2017 Jun;41(6):1584-1594. doi: 10.1007/s00268-017-3893-y.
Although the anti-inflammatory effects of immunomodulating diets (IMDs) have recently attracted attention, the efficacy of enteral feeding of such diets after radical surgery remains controversial. Thus, we conducted a new prospective, randomized controlled study to elucidate any beneficial effect of an IMD containing eicosapentaenoic acid (EPA) and γ-linolenic acid (GLA) in patients undergoing radical esophagectomy for thoracic esophageal cancer.
From November 2009 to July 2011, 87 consecutive patients were randomized to receive either an IMD enriched with EPA, GLA, and antioxidants (n = 42) or a standard isocaloric, isonitrogenous diet (control group, n = 45) after esophagectomy with radical lymphadenectomy. The primary outcome measure was changes in the oxygenation status (PaO/FIO ratio), and the secondary outcome measures were body composition, inflammation-related factors, coagulation markers, cholesterol concentrations, and major clinical outcomes.
Oxygenation was significantly better on postoperative days (PODs) 4, 6, and 8 in the IMD than control group (366.5 ± 63.3 vs. 317.3 ± 58.8, P = 0.001; 361.5 ± 52.6 vs. 314.0 ± 53.2, P < 0.001; 365.4 ± 71.2 vs. 315.2 ± 56.9, P = 0.001, respectively). Changes in the ratio of body weight on PODs 14 and 21 and lean body weight on POD 21 were significantly greater in the IMD than control group. No significant differences were observed in other measures.
An enteral IMD enriched with EPA and GLA improved oxygenation and maintained the body composition of patients undergoing radical esophagectomy, indicating the potential efficacy of such a diet after esophagectomy.
尽管免疫调节饮食（IMD）的抗炎作用近来受到关注，但根治性手术后肠内给予此类饮食的疗效仍存在争议。因此，我们开展了一项新的前瞻性随机对照研究，以阐明含二十碳五烯酸（EPA）和γ-亚麻酸（GLA）的IMD对胸段食管癌根治性食管切除术患者的有益作用。
2009年11月至2011年7月，87例连续患者在接受食管癌根治性淋巴结清扫术后被随机分为两组，分别接受富含EPA、GLA和抗氧化剂的IMD（n = 42）或标准等热量、等氮饮食（对照组，n = 45）。主要观察指标为氧合状态变化（PaO₂/FIO₂比值），次要观察指标为身体成分、炎症相关因子、凝血指标、胆固醇浓度及主要临床结局。
IMD组术后第4、6和8天的氧合情况显著优于对照组（分别为366.5 ± 63.3 vs. 317.3 ± 58.8，P = 0.001；361.5 ± 52.6 vs. 314.0 ± 53.2，P < 0.001；365.4 ± 71.2 vs. 315.2 ± 56.9，P = 0.001）。IMD组术后第14天和21天的体重变化以及术后第21天的去脂体重变化显著大于对照组。其他指标未观察到显著差异。
富含EPA和GLA的肠内IMD改善了根治性食管切除术患者的氧合情况并维持了其身体成分，表明此类饮食在食管切除术后具有潜在疗效。
