Immunonutrition in liver surgery

Immunonutrition enriched in arginine and omega-3 fatty acids (from fish oil) provided as a preoperative supplement to patients undergoing gastrointestinal surgery has been shown to almost halve postoperative infectious complications. To date, this treatment has not been investigated in patients undergoing liver surgery, except in one small study published in a Japanese medical journal. We will randomise patients scheduled for liver resection to an immunonutrition supplement to be taken preoperatively for 5 days or to standard care. Body composition assessments will be performed pre- and post-surgery and patients will be followed for 30 d post-surgery for complications. During liver resection, the liver is rendered ischaemic for a period of time before reperfusion occurs. Liver dysfunction together with mitochondrial dysfunction resulting in oxidative stress and an increased inflammatory reaction is a consequence of this ischaemia-reperfusion injury. This has been demonstrated in animal studies in which arginine and omega-3 acids have been shown to ameliorate the injury. Liver tissue samples will be collected at time of surgery for analysis of mitochondrial function and oxidative stress. The current pilot study is intended to examine the effects of preoperative nutrition with immune-modulatory properties on postoperative outcome in these patients in terms of liver mitochondrial function and oxidative stress, inflammatory response, muscle loss, and complication rates. These data will provide the foundation for a larger scale study with infectious complications as a primary end-point.