Enteric Immune-nutrition Formula (ANOM®) for Patients Receiving Major Upper Gastrointestinal Surgery

• immunological parameters [ Time Frame: POD 14 or discharged day ] [ Designated as safety issue: No ]
  we want to compare the immunological parameters, IL-6, with stand diet group
• Free radicles -TBARS [ Time Frame: POD 14 or discharged day ] [ Designated as safety issue: No ]
  we will esitimate the difference blood level of free radicles by ELISA and compared with that in the standard diet group
• immunological parameters [ Time Frame: POD14 or discharged day ] [ Designated as safety issue: No ]
  we will compare the immunological parameters, IL-8, with the stand diet group.
• immunological parameter [ Time Frame: POD14 or discharged day ] [ Designated as safety issue: No ]
  We will compare the immunological parameter, IL-1, with the standard diet group
• immunological parameter [ Time Frame: POD14 or discharged day ] [ Designated as safety issue: No ]
  We will compare the immunological parameter, IL-10, with the standard diet group
• immunological parameters [ Time Frame: POD14 or discharged day ] [ Designated as safety issue: No ]
  We will compare the immunological parameter, TNF-a, with the standard diet group

Perioperative usage of immunonutrition (ANOM®) can attenuate the pro-inflammatory cytokines and reduce postoperative infectious complications and length of hospital stay after major upper gastrointestinal surgery.

(ANOM®)immunonutrition product name

Background: Perioperative usage of immunonutrition can attenuate the pro-inflammatory cytokines and reduce postoperative infectious complications and length of hospital stay after major upper gastrointestinal surgery. The aim of this study was to elucidate the effect of immunomodulating diets, ANOM®, on surgical outcome in elective major upper gastrointestinal tract operations.

Material and Methods:

Design: Prospective, randomized, controlled trial. Participants: Seventy upper gastrointestinal tract cancer patients planned to undergo major upper gastrointestinal surgery in eesophagus、stomach、pancreas or duodenum, Interventions: Patients will be divided randomly into two groups to receive ANOM® or standard diet. Before surgery, 800ml ANOM® or standard diet (SEN) will be given for 5 days by mouth. After operation, 5% Distill water (D5W) combined with ANOM® or standard diet since the 2nd post-operation day (POD2) until day 14 (POD14) or until discharged day by enteric route using nasogastric tube(NG) tube or jejunostomy. Postoperative parenteral nutrition will be given to maintain adequate nutrition.

Clinical Assessment: The preoperative and postoperative immunological parameters, infection complications, and hospital stay will be compared.

Inclusion Criteria:

1. Age ranged from 18 to 80 years old
2. Patients with upper gastrointestinal diseases, and was planning to receive elective major upper gastrointestinal tract surgery, such as subtotal gastrectomy, proximal gastrectomy, total gastrectomy, esophagectomy, pancreatectomy, pancreaticoduodenectomy, duodenectomy, etc.
3. Patient is able to understand the requirements of the study and signs the Informed Consent Form.

Exclusion Criteria:

1. Patient with severe malnutrition condition, albumin < 2.6mg/ml
2. Patient with severe pulmonary, cardiovascular, renal or hepatic disease
3. Patient with immunosuppressive therapy or immunological disease recently
4. Patient with on-going infection with any condition
5. Patient with emergency operation
6. Patient with widespread metastatic disease before surgery
7. Patient with bowel obstruction disease
8. Investigator judges as subjects to be inappropriate for the clinical study (e.g., patient with severe complications)