The HepatoPancreaticoBiliary Resection Arginine Immunomodulation (PRIMe) Trial

Inclusion Criteria: * Patients age 18 and over at time of diagnosis * Resectable presumed liver, pancreas, or bile duct malignancy (i.e., liver metastases, HCC, cholangiocarcinoma, pancreatic or periampullary adenocarcinoma, NETs)as determined by surgeon in clinic * Anticipated hospital stay at least three days post-surgery * Ability to tolerate oral intake and comply with protocol requirements Exclusion Criteria: * Documented significant immunodeficiency due to underlying illness (e.g. HIV/AIDS) and/or medication (e.g. systemic corticosteroids, azathioprine, cyclosporin A). Subjects may be on physiologic doses of replacement prednisone or equivalent doses of corticosteroid (\<7.5 mg daily) * Subjects with resting hypotension (BP \<90/50 at rest) * History of autoimmune disease, such as but not restricted to, inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, or multiple sclerosis * Serious, active, intercurrent chronic or acute illness, or other active illness considered by the investigator as an unwarranted high risk for an investigational product * Active infection of any site and/or active herpes requiring ongoing treatment * Known pregnancy or nursing mothers * Subjects with an allergy to the nutritional supplement or comparator including milk, fish and/or shellfish allergies * Subjects with religious or other objections to consuming fish or shellfish * Subjects with severe asthma defined as asthma not controlled with inhale…