Major operations, such as radical cystectomy, is a risk factors for persistent pro-inflammatory reaction. As a result of this persistent pro-inflammatory condition, a poorer cancer prognosis may result. This is due to the pro-inflammatory conditions that may promote tumor growth and survival, as well as increase angiogenesis. Nutrition that modulates immune responses has been shown to restore baseline levels of immunity. In this study, we examined the role of perioperative immunomodulatory nutrition in modulating the effects of major surgery, radical cystectomy, on the levels of Il-10, CD4+, CD8+, and albumin.

This study was a prospective, randomized controlled trial (RCT) designed to evaluate the effects of immunomodulation nutrition compared to standard of care on immune and nutritional markers in patients undergoing radical cystectomy and ureterocutaneostomy as urinary diversion. Group 1 (Intervention): Participants received immunomodulation nutrition. The supplementation was administered for 7 days pre-operation and continued for 14 days post-operation. Group 2 (Control): Participants received an equivalent volume of milk powder (providing extra protein) diluted in water, administered for 7 days pre-operation and continued for 14 days post-operation. Blood samples were collected at baseline and post-intervention to measure IL-10 (ELISA), CD4/CD8 lymphocytes (flow cytometry), and serum albumin (spectrophotometry). Data were analyzed using statistical software (SPSS/R). Normality was assessed via the Shapiro-Wilk test; independent t-tests, Mann-Whitney U tests, and Kruskal-Wallis tests were used accordingly. Statistical significance was set at p<0.05.

There were 11 male and 2 female in each group with mean age 60.7 (SD 7.84) and 62.6 (SD 7.72) for group 1 and group 2, respectively. There was no significant difference between both groups in CD4+, CD8+, Il-10 and albumin levels at the baseline. Mean levels of albumin at the baseline on both groups is slightly lower than normal. In group 2 there is a statistically significance reduction of CD4+ and CD8+ levels compare to baseline. While in group 1 there was no statistically significant difference from baseline. Il-10 in group 1 had a statistically significant greater decline compare to group 2. There was a statistically significant decline in albumin levels in both groups compare to baseline.

A perioperative immunomodulatory nutrition regimen has an effect on modulating the levels of Il-10, CD4+, CD8+, and albumin after radical cystectomy. This shows that immuno-nutrition is important in during radical cystectomy perioperative periods.