Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery


  • Presented in part to meetings of the European Society of Esophagology, Dublin, Ireland, September 2007, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, Cardiff, UK, September 2007, Association of Surgeons of Great Britain and Ireland, Bournemouth, UK, May 2008, Digestive Diseases Week, San Diego, California, USA, May 2008, International Society of Diseases of the Esophagus, Budapest, Hungary, September 2008, and the European Surgical Association, Vienna, Austria, April 2009; published in abstract form as Irish J Med Sci 2007; 176(Suppl 5): S213–S214, Br J Surg 2007; 94(Suppl 5): 18, Br J Surg 2008; 95(Suppl 3): 83 and Gastroenterology 2008; 134(Suppl 1): A-27



Oesophagogastric cancer surgery is immunosuppressive. This may be modulated by omega-3 fatty acids (O-3FAs). The aim of this study was to assess the effect of perioperative O-3FAs on clinical outcome and immune function after oesophagogastric cancer surgery.


Patients undergoing subtotal oesophagectomy and total gastrectomy were recruited and allocated randomly to an O-3FA enteral immunoenhancing diet (IED) or standard enteral nutrition (SEN) for 7 days before and after surgery, or to postoperative supplementation alone (control group). Clinical outcome, fatty acid concentrations, and HLA-DR expression on monocytes and activated T lymphocytes were determined before and after operation.


Of 221 patients recruited, 26 were excluded. Groups (IED, 66; SEN, 63; control, 66) were matched for age, malnutrition and co-morbidity. There were no differences in morbidity (P = 0·646), mortality (P = 1·000) or hospital stay (P = 0·701) between the groups. O-3FA concentrations were higher in the IED group after supplementation (P < 0·001). The ratio of omega-6 fatty acid to O-3FA was 1·9:1, 4·1:1 and 4·8:1 on the day before surgery in the IED, SEN and control groups (P < 0·001). There were no differences between the groups in HLA-DR expression in either monocytes (P = 0·538) or activated T lymphocytes (P = 0·204).


Despite a significant increase in plasma concentrations of O-3FA, immunonutrition with O-3FA did not affect overall HLA-DR expression on leucocytes or clinical outcome following oesophagogastric cancer surgery. Registration number: ISRCTN43730758 (http://www.controlled-trials.com). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.