Prevention of postoperative infection and micrometastasis by preoperative administration of a PPARgamma agonist following colorectal cancer surgery.

Several clinical studies have suggested that systemic inflammatory response syndrome (SIRS) following major surgical trauma is a main cause of postoperative infections and multiple organ failure. The underlying mechanisms of this increased susceptibility to infection due to postoperative immune suppression have been recognized as follows; release of endogenous immune suppressant, interleukin-6 (IL-6), prostaglandin E2, and IL10; Th1 Th2 balance shifts toward Th2 dominance, and the deactivation of monocytes. We have demonstrated that the Th1 Th2 ratio in patients with postoperative infection was significantly lower than that in patients without infection following colorectal cancer surgery. Furthermore, preoperative immunonutrition by oral supplementation with a formula enriched with arginine, omega-3 fatty acids and ribonucleic acid improves the normalization of Th1 Th2 ratio and decreases the morbidity rate following colorectal cancer surgery. Obesity, the most common nutritional disorder might be associated with postoperative infection morbidity rates. However, the molecular basis of the correlation between obesity and postoperative infection has not been fully clarified.