Omega-3 Polyunsaturated Fatty Acids in the Prevention of Postoperative Complications in Colorectal Cancer: A Meta-analysis
the ONA take:
Short-term treatment with omega-3 polyunsaturated fatty acids (PUFAs) appears to be associated with a reduced risk for developing postoperative complications, decreased inflammatory cytokines, and a shortened hospital stay after surgery for colorectal cancer, according to a study published in the journal OncoTargets and Therapy.1
Because previous meta-analyses including all kinds of surgical patients have suggested that omega-3 PUFAs improved clinical outcomes, researchers sought to determine the influence of omega-3 PUFA supplementation in patients who have undergo colorectal cancer surgery. For this meta-analysis, investigators analyzed data from 694 patients with colorectal cancer included in 11 studies.
Results showed patients who received omega-3 PUFA-enriched enteral or parenteral nutrition during the perioperative period had a 37% reduced risk for developing infectious complications compared with controls (relative risk [RR], 0.63; 95% CI, 0.47-0.86; P =.004). Investigators also found that patients who received omega-3 PUFA-enriched nutrition had reduced inflammatory cytokines, including tumor necrosis factor alpha (P =.01) and interleukin-6 (P =.01).
Patients in the omega-3 PUFA group had a shorter hospital stay of approximately 2 days on average (P =.01); however, investigators observed no significant difference in total complications, surgical site infection, or CD4+ to CD8+ cell ratio.
Although this study suggests that inclusion of omega-3 PUFAs in enteral or parenteral nutrition during the perioperative period improves outcomes for this population, this study is limited by its relatively small sample size and heterogeneity across the trials assessed. Therefore, a larger study with longer follow-up is needed to confirm these results and determine the optimal timing and route of administration of omega-3 PUFA supplementation in this setting.
OncoTargets and Therapy
Objective: To evaluate systematically the clinical efficacy of omega-3 polyunsaturated fatty acids (PUFAs) in the prevention of postoperative complications in colorectal cancer (CRC) patients.
Materials and methods: Published articles were identified by using search terms in online databases – PubMed, Embase, and the Cochrane Library – up to March 2016. Only randomized controlled trials investigating the efficacy of omega-3 PUFAs in CRC were selected and analyzed through a meta-analysis. Subgroup, sensitivity, and inverted funnel-plot analyses were also conducted.
Results: Eleven articles with 694 CRC patients were finally included. Compared with control, omega-3 PUFA-enriched enteral or parenteral nutrition during the perioperative period reduced infectious complications (risk ratio [RR] 0.63, 95% confidence interval [CI] 0.47–0.86; P=0.004), tumor necrosis factor alpha (standard mean difference [SMD] -0.37, 95% CI -0.66 to -0.07; P=0.01), interleukin-6 (SMD -0.36, 95% CI -0.66 to -0.07; P=0.02), and hospital stay (MD -2.09, 95% CI -3.71 to -0.48; P=0.01). No significant difference was found in total complications, surgical site infection, or CD4+:CD8+ cell ratio.
Conclusion: Short-term omega-3 PUFA administration was associated with reduced postoperative infectious complications, inflammatory cytokines, and hospital stay after CRC surgery. Due to heterogeneity and relatively small sample size, the optimal timing and route of administration deserve further study.
Keywords: omega-3, fatty acids, fish oil, colorectal surgery, meta-analysis