Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery

Three-arm randomized, double-blind trial involving 195 adults with histologically proven oesophagogastric cancer undergoing curative subtotal oesophagectomy or total gastrectomy. Groups were matched for age, BMI, malnutrition and comorbidity. Primary endpoint: postoperative infective complications.

IED: Omega-3 fatty acid–enriched enteral immunoenhancing diet (Oxepa), 675 ml/day to provide ~1000 kcal/day, started 7 days before and continued for 7 days after surgery (outpatient preoperative therapy). SEN: Standard enteral nutrition (EnsurePlus), 675 ml/day (~1000 kcal/day), started 7 days before and continued for 7 days after surgery. Control: Postoperative supplementation only; no preoperative nutritional support; postoperative Osmolite as required and adjusted per clinical needs.

No differences among groups in overall infective complications, morbidity, mortality, or length of hospital stay. O-3 fatty acids increased in the IED group after supplementation (P<0.001) and reduced the omega-6/omega-3 ratio; HLA-DR expression on monocytes and stimulated T lymphocytes showed no group differences. Conclusion: Despite higher plasma omega-3 levels, perioperative omega-3 immunonutrition did not affect immune markers or clinical outcomes after oesophagogastric cancer surgery.

Not all participants reached the maximum prescribed feeding rate (roughly 46.7% achieved target maximum hourly rate); adherence and tolerance issues affected delivery of intended doses; energy/protein delivery varied between groups; to detect a meaningful infection reduction would require a sample size >1800; applicability may be limited to this cancer surgery setting.