Preoperative Glutamine Supplementation in Gastric Cancer-Thrombocyte Phagocytic Activity and Early Postoperative Outcomes.

BACKGROUND: The aim of this study was to determine the phagocytic activity of thrombocytes in patients with gastric cancer and to assess the effect of oral and parenteral preoperative glutamine-based immunonutrition on nutritional status, thrombocyte phagocytic activity, and early postoperative outcomes. METHODS: Patients suffering from invasive gastric cancer had been treated with preoperative immunonutrition with glutamine, and they were compared to patients without nutritional treatment. Nutritional status, percentage of weight loss, and BMI were assessed. Levels of total protein, albumin, cholesterol, triglycerides, platelets, and their phagocytic ability were measured twice. Postsurgical complications were assessed via the Clavien-Dindo classification. RESULTS: Group I consisted of 20 patients with an oral glutamine-10 g daily. Group II had 38 patients who received intravenous glutamine, 1.5 mL per kg body weight of Dipeptiven. Group III consisted of 25 patients who did not receive preoperative immunonutrition. In total, 47% of patients in Group I, 54% of patients in Group II, and 33% of patients in Group III were malnourished. In Group I, the percentage of phagocytizing platelet (%PhP) was 1.1 preoperatively and 1.2 postoperatively. The phagocytic index (PhI) was 1.0 and 1.1. In Group II, %PhP was 1.1 and 1.2 and PhI was 1.0 and 1.1. In Group III, the %PhP was 1.0 and 1.2 and PhI was 1.0 and 1.1. An increase in triglyceride level was observed in both immunonutrition groups. There was a decline in total protein and albumin level in Group II. In Group III, there was a decline in total protein, albumin, and cholesterol level. The total platelet count and PhI were increased in both immunonutrition groups. There was also a rise in %PhP in Group II. In Group III, there was a rise in blood platelet level, %PhP, and PhI. The complication rates were 53% in Group I, 29% in Group II, and 40% in Group III. CONCLUSIONS: In invasive gastric cancer, laboratory nutritional parameters are significantly reduced, causing malnutrition in 44.7% of patients. Oral glutamine supplementation inhibited the postoperative decline in protein metabolism parameters; however, this did not affect the reduction in the percentage of postoperative complications. Glutamine used preoperatively significantly reduced the percentage of serious surgical complications, regardless of the way it was supplemented. Patients with invasive gastric cancer have a significant decrease in platelet phagocytic activity. The administered preoperative parenteral nutrition and the surgical procedure itself influenced the improvement of the phagocytic activity of blood platelets. Glutamine did not have this effect, regardless of the route of administration.

[The effect of surgical and nutritional treatment on activation parameters of peripheral blood T lymphocytes in stomach cancer patients in postoperative period]. / Wplyw leczenia chirurgicznego i zywieniowego w okresie pooperacyjnym na wybrane parametry aktywacji limfocytów T krwi obwodowej chorych na raka zoladka.

UNLABELLED: Several studies have reported that patients with stomach cancer are frequently affected by malnutrition. Malnourished patients are at risk of postoperative complications. Immune function starts to deteriorate when weight loss exceeds 15%. Early enteral nutrition support reduces postoperative lymphocytopenia. T lymphocytes are central elements of the immune system. CD69, CD25 and HLA-DR molecules are expressed following activation on T lymphocytes surface. THE AIM OF THE STUDY was to assess the effect of surgery and early postoperative enteral nutrition on peripheral blood T lymphocytes activation status in stomach cancer patients. MATERIAL AND METHODS: Lymphocyte T CD: CD3/CD69, CD3/CD25, CD3/HLA-DR were determined in 30 stomach cancer patients before treatment and 1, 3, 7 and 10 days after gastrectomy. Patients received early enteral nutrition from 20 hours to 7 days after surgery. The obtained results were compared with the results of 30 healthy volunteers. RESULTS: The significant deficiency of total T lymphocyte number was found in stomach cancer patients before surgery and in postoperative period in comparison with the control group. The populations of CD3+/CD69+, CD3+/CD25+ and CD3+/HLA-DR+ T lymphocytes in patients with stomach cancer were significantly higher in comparison with healthy donors. The significant increase of percentage of activated T lymphocytes was observed, too. CONCLUSIONS: The obtained data demonstrated significant quantitative defect in T lymphocytes and significant increase of their activation status in stomach cancer patients. Surgical procedure intensified changes that were observed before treatment. The most dynamic changes were observed in CD3+/CD69+ T cells population.