The Nutritional Therapeutic Modality Of ω-3Fatty Acid-based Parenteral Nutrition For Liver Cancer Patients After Hepatectomy

BACKGROUND:Perioperative management is intractable for surgeons to performhepatectomy for liver cancer patients with cirrhosis.Surgeons often get into a dilemma notonly because of the increased morbidity and mortality as a result of malnutrition but alsoparenteral nutrition-associated liver disease(PNALD).Despite of the increasing interest inω-3fatty acid-supplemented lipid emulsion,few studies are known about perioperativetransfusion of ω-3fatty acid-supplemented lipid emulsion on the patients with hepaticfibrosis and chronic aggressive hepatitis followed hepatectomy.OBJECTIVE: This study aimed to explore the safety and nutritional therapeutic modalityof ω-3fatty acid-based parenteral nutrition for these patients.METHODS:A total of105patients were diagnosed as liver cancer preoperatively andhepatectomy was performed on them.The patients were randomly divided into trial groupand control group.Structolipid and Omegaven(Fresenius-Kabi,Germany) were applied tothe trial group but only structolipid to the control group at the operation day and the regimewas consecutive for5days postoperatively.Non-protein energy requirement was defined as 25Kcal/kg-1d-1.The supply quantity of glucose,lipid emulsion and amino acids was based onESPEN Guidelines2009.The Blood samples were collected at7:00～8:00at A.M. at day0,1,3and5,but the urine sample was collected from day0to day5.The Intake and loss offluid were recorded.RESULTS:The urinary albumin-creatinine ratio(ACR) at day3,4and5and the levels ofserum ALT and Hs-CRP at day3and5in the trial group were significantly lower than thatin the control group(P＜0.02).The volume of positive fluid balance was4282.35±1333.07ml in the control group,significantly higher than that(3564.15±1197.93ml) in thetrial group(P=.005).In addition,the emerging time of negative fluid balance was44.90±13.57h after surgery,significantly later than that in the trial group (36.19±12.29h)(P=.001).The value of ΔPT at day5was significantly higher in the trial group than that inthe control group(P=.004).The total morbidity of complications was50.00%(26/52) in thecontrol group,but28.31%(15/53) in the trial group(P=.028).The total mortality in the twogroups was not statistically different.CONCLUSIONS: Omega-3fatty acid-based parenteral nutrition is safe and has beenproved to have anti-inflammatory potential to stabilize hepatocyte membranes andpresents cholagogue effect by interfering with the arachidonic acid pathway and producingthe anti-inflammatory cytokines.The reduce of the volume of positive fluid balance and theturning up of negative fluid balance in advance signifies inflamamatory response disappearsearlier owing to Omegaven transfusion.In conclusion, ω-3fatty acid is changing thetraditional paradigm—the transition from nutritional support to nutritional therapeuticmodality.