George Jason, White Daniel, Fielding Barbara, Scott Michael, Rockall Timothy, Whyte Martin Brunel
Minimal Access Therapy Training Unit, Guildford, UK.
University of Surrey Faculty of Health and Medical Sciences, Guildford, UK.
BMJ Surg Interv Health Technol. 2023 Jun 23;5(1):e000172. doi: 10.1136/bmjsit-2022-000172. eCollection 2023.
Perioperative nutrition aims to replenish nutritional stores before surgery and reduce postoperative complications. 'Immunonutrition' (including omega-3 fatty acids) may modulate the immune system and attenuate the postoperative inflammatory response. Hitherto, immunonutrition has overwhelmingly been administered in the postoperative period-however, this may be too late to provide benefit.
A systematic literature search using MEDLINE and EMBASE for randomized controlled trials (RCTs).
Perioperative major gastrointestinal surgery.
Patients undergoing major gastrointestinal surgery.
Omega-3 fatty acid supplementation commenced in the preoperative period, with or without continuation into postoperative period.
The effect of preoperative omega-3 fatty acids on inflammatory response and clinical outcomes.
833 studies were identified. After applying inclusion and exclusion criteria, 12 RCTs, involving 1456 randomized patients, were included. Ten articles exclusively enrolled patients with cancer. Seven studies used a combination of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) as the intervention and five studies used EPA alone. Eight out of 12 studies continued preoperative nutritional support into the postoperative period.Of the nine studies reporting mortality, no difference was seen. Duration of hospitalisation ranged from 4.5 to 18 days with intervention and 3.5 to 23.5 days with control. Omega-3 fatty acids had no effect on postoperative C-reactive protein and the effect on cytokines (including tumor necrosis factor-α, interleukin (IL)-6 and IL-10) was inconsistent. Ten of the 12 studies had low risk of bias, with one study having moderate bias from allocation and blinding.
There is insufficient evidence to support routine preoperative omega-3 fatty acid supplementation for major gastrointestinal surgery, even when this is continued after surgery.
CRD42018108333.
围手术期营养旨在术前补充营养储备并减少术后并发症。“免疫营养”（包括ω-3脂肪酸）可能调节免疫系统并减轻术后炎症反应。迄今为止，免疫营养绝大多数是在术后给予的——然而，这可能为时已晚而无法带来益处。
使用MEDLINE和EMBASE对随机对照试验（RCT）进行系统文献检索。
围手术期的大型胃肠道手术。
接受大型胃肠道手术的患者。
术前开始补充ω-3脂肪酸，术后可继续或不继续补充。
术前ω-3脂肪酸对炎症反应和临床结局的影响。
共识别出833项研究。应用纳入和排除标准后，纳入了12项RCT，涉及1456例随机分组的患者。10篇文章专门纳入了癌症患者。7项研究使用二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）的组合作为干预措施，5项研究仅使用EPA。12项研究中有8项在术后继续术前营养支持。在报告死亡率的9项研究中，未发现差异。干预组的住院时间为4.5至18天，对照组为3.5至23.5天。ω-3脂肪酸对术后C反应蛋白无影响，对细胞因子（包括肿瘤坏死因子-α、白细胞介素（IL）-6和IL-10）的影响不一致。12项研究中有10项偏倚风险较低，1项研究在分配和盲法方面存在中度偏倚。
没有足够的证据支持对大型胃肠道手术常规术前补充ω-3脂肪酸，即使术后继续补充也不支持。
PROSPERO注册号：CRD42018108333。
