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The impact of preoperative micronutrient supplementation in lung surgery. A prospective randomized trial of oral supplementation of combined -ketoglutaric acid and 5-hydroxymethylfurfural

^a Department of Surgery, Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
^b Department of Anesthesiology, Medical University Graz, Graz, Austria
^c Institute of Physiological Chemistry, Centre of Medical Physiology, Medical University Graz, Graz, Austria
^d Institute of Biomedical Research, Medical University Graz, Graz, Austria
^e Institute of Clinical Pharmacology, Medical University Graz, Graz, Austria

Received 28 February 2007; received in revised form 28 June 2007; accepted 13 July 2007.

^_* Corresponding author. Address: Department of Surgery, Division of Thoracic and Hyperbaric Surgery, University Medical School, Auenbruggerplatz 29, A-8036 Graz, Austria. Tel.: +43 316 385 3302; fax: +43 316 385 4679. (Email: alf.maier{at}meduni-graz.at).

Objective: Preoperative micronutrient supplementation in fast-track surgery programs have shown to reduce complications, shorten recovery, and thereby lower costs. In a prospective randomized study, the metabolic effects of a combination of -ketoglutaric acid (-KG) and 5-hydroxymethylfurfural (5-HMF) were evaluated concerning their impact on improvement of exercise capacity and reduction of oxidative stress in lung surgery. Methods: Thirty-two consecutive patients admitted for lung resection due to NSCLC were randomized to the study protocol. All patients received preoperative nutritional guidelines according to general recommendations. In 16 (study group), a supplementation of 7.2 g -KG and 720 mg 5-HMF/day (SANOPAL^®) was administered from days 1 to 10. Spiroergometric evaluation was carried out at baseline and day 10 after micronutrient supplementation. Blood samples for the determination of oxidative stress, i.e. carbonyl proteins (CPs) and isoprostanes (IPs) were taken on at baseline, in the operating room just before resection treatment, and 25 min after single lung ventilation (SLV). Results: Spiroergometric re-evaluation showed a significant increase of (p = 0.0108) and Watt's (p = 0.011) in favor of the study group. Determination of oxidative stress showed a significant reduction of CPs before (p = 0.048) and after SLV (p = 0.0001) for the study group compared to the control group. The same is true for IPs before (p = 0.003) and after SLV (p = 0.02). Hospitalization and intensive care unit (ICU) of the study group showed a significant reduction compared to the control group (p = 0.03 and p = 0.02, respectively). Conclusions: Simple oral supplementation using a combination of -KG and 5-HMF of preoperative micronutrition may therefore be one further step in a multimodality approach of fast-track surgery programs also in lung surgery.

Key Words: Preoperative micronutrient supplementation • Lung cancer • Preoperative care • Surgery • Preconditioning