Perioperative omega-3 fatty acids for liver surgery

Abstract

Introduction: The effect of perioperative omega-3 fatty acids for liver surgery remained controversial. We conducted a systematic review and meta-analysis to explore the influence of omega-3 fatty acids versus placebo in patients undergoing liver surgery. Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020, and included randomized controlled trials (RCTs) assessing the effect of omega-3 fatty acids versus placebo for liver surgery. This meta-analysis was performed using the random-effect model. Results: Five RCTs were included in the meta-analysis. Overall, compared with control group for liver surgery, omega-3 fatty acids were associated with substantially reduced incidence of infection (odd ratio [OR]=0.56; 95% confidence interval [CI] =0.34–0.91; P = .02), but revealed no remarkable influence on complications (OR = 0.60; 95% CI = 0.29–1.24; P = .17), mortality (OR = 0.76; 95% CI = 0.06–9.37; P = .83), liver failure (OR = 0.72; 95% CI = 0.10 to 5.00; P = 0.74), biliary leakage (OR=1.24; 95% CI = 0.41 to 3.76; P = .70), bleeding (OR = 1.76; 95% CI = 0.63–4.95; P = .28), or ileus (OR = 0.39; 95% CI = 0.07–2.05; P = .27). Conclusion: Perioperative omega-3 fatty acids may be beneficial to reduce the incidence of infection after liver surgery.

Effects of Omega-3 Polyunsaturated Fatty Acids, Docosahexaenoic Acid and Eicosapentaenoic Acid, on Post-Surgical Complications in Surgical Trauma Patients: Mechanisms, Nutrition, and Challenges

“…However, a reduction in the risk of complications was observed only when omega-3 was continuously provided in the perioperative period, rather than in the pre-or post-operative period alone. Additionally, no effects were observed in the cases of mortality, liver failure, biliary leakage, bleeding, or ileus [13]. The methodologically strongest and most recent RCT (n = 261 patients) included in the meta-analysis, conducted by Linecker et al [16], revealed that the intravenous administration of omega-3 perioperatively (100 mL Omegaven) failed to confer protection against post-operative complications after liver surgery.…”

“…A meta-analysis conducted in May 2020 on patients who underwent liver tumor surgery revealed that omega-3 was considerably effective in reducing the incidence of postoperative infections [13]. However, a reduction in the risk of complications was observed only when omega-3 was continuously provided in the perioperative period, rather than in the pre-or post-operative period alone.…”

“…Due to the anti-inflammatory and immunomodulatory properties of omega-3 PU-FAs, their use is strongly recommended in cases involving a hyper-inflammatory state, such as surgeries [7,[9][10][11][12][13][14][15]. DHA and EPA serve as the foundational components for antiinflammatory lipid mediators and specific pro-resolving lipid mediators [16].…”

Clearing Steatosis Prior to Liver Surgery for Colorectal Metastasis: A Narrative Review and Case Illustration

“…Omega-3 fatty acids (Ω3 FA) supplementation has been explored to ameliorate hepatic steatosis in both animal and human models in the setting of liver disease [154][155][156][157]. In particular, Clavien et al demonstrated that Ω3 FA implementation can ameliorate ischemic/reperfusion injuries in ob/ob mice that undergo 45 min of segmental (70%) hepatic ischemia [154].…”

Does inclusion of bioactive n-3 PUFAs in parenteral nutrition benefit postoperative patients undergoing liver surgery? A systematic review and meta-analysis of randomised control trials

“…The mechanism may be associated with the competitive inhibition of the proinflammatory property of arachidonic acids (AA) and cytokines by the conversion of EPA and DHA to prostaglandin series 3 (PGE3, PGI3 and TXA3) and leukotrienes series 5 (LTB5, LTC5 and LTD5) 26 27. Therefore, various reports have shown that increasing the ratio of n-3: n-6 PUFAs in the PN emulsion on preoperative or postoperative patients undergoing liver surgery can improve prognosis 28–30…”