Abstract
Objective: The present study aimed to investigate the effectiveness of parenteral nutritional support with ω-3 PUFAs–based lipid emulsions in patients after liver resection. Methods: A total of 119 patients were randomly assigned to the immunonutrition (IM) group (n = 59) and control group (n = 60). The IM group was continuously given Omegaven® 10% 100 mL/day rather than regular nutrition for five days postoperatively. Venous blood samples were obtained from all subjects before surgery and D1, D3 and D7 after surgery. Results: No significant difference was found in baseline characteristics of the two groups. On D1 after surgery, no statistically significant differences were observed in the blood sample tests between the two groups. On D3 after surgery, the levels of white blood cell count (WBC), alanine aminotransferase (ALT), aspartate transaminase (AST) and total bilirubin (TBil) were dramatically decreased in the IM group (t = 3.065, p = 0.003; t = 2.149, p = 0.034; t = 5.313, p= 0.001; and t = 2.419, p = 0.017, respectively). Furthermore, on D7 after surgery, not only could a significant decrease be observed in the IM group concerning the levels of WBC, ALT and TBil (t = 3.025, p = 0.003; t = 2.094, p = 0.038; and t = 2.046, p = 0.043, respectively), but it was also seen in the level of Δprothrombintime (PT) (t = 2.450, p = 0.016). An increase in the level of prealbumin (Pre-Alb) in the IM group was observed on D7 after surgery (t = 2.237, p = 0.027). The frequency of total complications in the IM group were significantly lower than in the control group (χ2 = 4.225, p = 0.040 and χ2 = 3.174, p = 0.075). The trend favored the IM group in reducing the total infective complications rate (χ2 = 3.174, p = 0.075). A significant decrease in the duration of the hospital stay after surgery was also observed in the IM group (t = 2.012, p = 0.047).Conclusion: ω-3 PUFAs–based lipid emulsions for treatment of patients after hepatectomy are safe and effective in controlling inflammation, protecting liver function, and consequently reducing the rate of total complications and the duration of the hospital stay.
Highlights
Liver resection is the primary treatment for hepatic masses, especially malignant solid tumors, such as in liver cancer or liver metastasis
Concerning baseline characteristics of the two groups, no significant difference was found with respect to age, gender, BMI, Child-pugh score, indocyanine green (ICG) R15, pathology, resection range, blood loss, Pringle time or surgery time (Table 1)
Clinical evidence showed that ω-3 PUFAs and other nutrients, such as immune glutamine, arginine, nucleosides and dietary fiber, could reduce excessive inflammatory reaction and modulate the immune response in cancer, surgical, and critically ill patients [6]
Summary
Liver resection is the primary treatment for hepatic masses, especially malignant solid tumors, such as in liver cancer or liver metastasis. The prevalence of malnutrition is common among patients with advanced liver disease [1]. Perioperative nutritional support can significantly reduce the postoperative complications and/or mortality in patients with liver resection [2,3]. Considering liver dysfunction after ischemia-reperfusion injury, inflammatory response, nutrient metabolism. Nutrients 2016, 8, 357 abnormalities, and difference in liver cirrhosis status or resection range, nutritional support could be fraught with obstacles needing to be overcome. Postoperative nutritional support after liver resection must be individually and insightfully implemented. Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) are long-chain fatty acids including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA)
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