Immunonutrition before cancer surgery
Drinks enriched with arginine, omega-3 fats and nucleotides for a week before a big operation seem to reduce infections afterwards, though the trials are old and mostly industry-funded.
Immune-modulating formulas (arginine, omega-3 fatty acids, RNA nucleotides) given for 5-7 days pre-operatively reduced infectious complications and length of stay in meta-analyses of gastrointestinal and head and neck cancer surgery, with the largest effects in malnourished patients. ESPEN and ERAS guidelines recommend or suggest them for major upper GI and head and neck surgery. The caveats are real: many trials date from the 1990s and 2000s, most were manufacturer-sponsored, heterogeneity is high, and recent well-conducted trials have been null. Whether the benefit is from the immune-modulating components or simply from feeding malnourished patients is unresolved.
How it works
Arginine supports T-cell function and nitric oxide-dependent wound healing; omega-3 fatty acids shift eicosanoid synthesis towards less inflammatory mediators; nucleotides supply rapidly dividing immune and gut cells.
- Reduced infectious complications in pooled analyses
- Cheap and simple to deliver in the pre-operative window
- Evidence base is old and largely industry-funded
- Recent trials less positive
- Unclear whether the specific nutrients matter
Latest papers
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