A199
The effect of omega-3 fatty acids (O-3FA) on antioxidant status, human leukocyte antigen (HLA)-DR expression on leukocytes and clinical outcome in oesophago-gastric cancer surgery (OGCS)
Javed Sultan1, Filippo Di Franco1, Chris.J Seal2, John.A Kirby3, Brian.K Shenton3, S.Michael Griffin1
1Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK, 2School of Agriculture, Food and Rural Development, University of Newcastle, Newcastle upon Tyne, UK, 3School of Surgical and Reproductive Sciences, University of Newcastle, Newcastle upon Tyne, UK
Background
Patients undergoing OGCS are at an increased risk of oxidative stress and immunosuppression. This may be modulated by O-3FA with subsequent improvement in morbidity. Our aims were to study the effect of perioperative O-3FA on antioxidant status, oxidative damage, HLA-DR expression on monocytes and activated T lymphocytes and clinical outcome in OGCS.
Method
Subtotal oesophagectomy and total gastrectomy patients were recruited into a randomised trial (April 2003 to January 2007, n=221): O-3FA immunonutrition (IED) or isocaloric and isonitrogenous standard enteral nutrition (SEN) 7 days pre- and post-operatively or a control (C) group receiving post-operative supplementation only. Plasma total antioxidant capacity (TAC, ferric reducing antioxidant capacity and Trolox equivalent antioxidant capacity, n=112), malondialdehyde as a marker of oxidative damage (MDA) and fatty acid (FA) concentrations were measured 7 and 1 day pre- and post-operatively along with clinical data. HLA-DR expression was measured by flow cytometry (n=45).
Results
Of the patients recruited, 26 were excluded. Groups were matched for age, malnutrition and co-morbidity (IED n=66, SEN n=63, C n=66). O-3FA concentrations were higher in IED after supplementation (p<0.001). The ratio of O-6FA:O-3FA was 1.9:1, 4.1:1 and 4.8:1 one day operatively in IED, SEN and C arms respectively (p<0.001). HLA-DR expression on monocytes increased preoperatively in IED arm (p=0.04), whereas it decreased marginally in SEN and C arm (p=ns). Throughout the perioperative period, there was a trend towards upregulation in the percentage of activated T lymphocytes in the IED arm only (p=ns). There was an overall significant effect of surgery on TAC and MDA (p<0.01). However, morbidity, mortality, hospital stay, TAC and MDA were comparable between the arms (p=ns).
Conclusion
Despite a significant increase in plasma concentrations of O-3FAs with upregulated HLA-DR expression on monocytes prior to surgery and a trend towards upregulated activation of T lymphocytes post-surgery, immunonutrition with O-3FAs, does not affect antioxidant status or clinical outcome following OGCS.
