Preoperative immunonutrition as a strategy for reducing oxidative stress and inflammation in pancreatic ductal adenocarcinoma.

INTRODUCTION: The aim of this study was to evaluate the effect of preoperative immunonutrition (IMN) on oxidative stress parameters and inflammatory cytokine concentrations in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection. METHODS: The study included 52 patients with PDAC, who were divided into two groups: group 1 (n = 26), which received an immunonutrition formula (Impact Oral®) for seven days before surgery, and group 2 (n = 26), comprising patients who did not receive preoperative nutritional support. The control group consisted of 40 healthy individuals. Oxidative status parameters (Total Antioxidant Capacity -TAC, Total Oxidative Status - TOS, and Oxidative Stress Index -OSI, ferric reducing antioxidant power - FRAP), protein glycoxidation markers (Advanced Glycation End Products - AGEs, Advanced Oxidation Protein Products - AOPPs), lipid peroxidation markers (Malondialdehyde - MDA), and cytokine concentrations (IL1α, IL1β, IL6, IL10, and tumor necrosis factor - TNFα) were analyzed at three time points: upon admission, after seven days of nutritional intervention (before surgery), and on postoperative day 10. RESULTS: Patients with PDAC exhibited significantly higher levels of oxidative stress and lower antioxidant potential than the control group. The redox balance was significantly improved, and the concentrations of pro-inflammatory cytokines (IL1α, IL1β, and IL6) decreased after seven days of immunonutrition. However, surgery led to a rapid increase in oxidative stress in both study groups. DISCUSSION: Preoperative immunonutrition is an effective strategy for alleviating oxidative stress and the systemic inflammatory response in patients with PDAC, thereby improving preoperative preparation for surgical resection, which could play a key role in postoperative recovery in this patient population.