Effects of a preoperative immune-modulating diet in patients with esophageal cancer: a prospective parallel group randomized study

The aim of this pilot study was to investigate the effects of a preoperative immune-modulating diet (IMD) before thoracoscopic esophagectomy for patients with esophageal cancer. Thirty patients who were diagnosed with resectable esophageal cancer were assigned to two groups: the IMD (n = 15) and the standard liquid diet (SLD; n = 15) groups. We evaluated postoperative parameters, such as the incidence of complications and the postoperative levels of cytokines as the primary endpoints. The secondary endpoint was the length of hospital stay. The peak levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha appeared on postoperative day (POD) 1 and POD 2 in the IMD and SLD group, respectively. The peak level of C-reactive protein (CRP) appeared on POD 3 in both groups (IMD 9.9 mg/dL, SLD 15.2 mg/dL). Overall, TNF-alpha levels in the IMD group were lower than those in the SLD group (P = 0.033). Furthermore, IL-6 (P = 0.182) and CRP (P = 0.191) levels, and the incidence of postoperative pneumonia (7.1 vs. 26.7%; P = 0.330) tended to be lower in the IMD group than in the SLD group. Preoperative IMD suppressed the elevation of the TNF-alpha levels after thoracoscopic esophagectomy in patients with esophageal cancer, although no different tendency was detected in terms of IL-6, CRP or postoperative complications.