Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer

Chen, Lantao; Sun, Lixin; Lang, Yaoguo; Wu, Jun; Yao, Lei; Ning, Jinfeng; Zhang, Jinfeng; Xu, Shidong

doi:10.1186/s12885-016-2506-8

Cited by 56 publications

(46 citation statements)

References 25 publications

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“…Nevertheless, there was significant heterogeneity between the studies in terms of enhanced recovery protocols, surgical approach, and utilization of neoadjuvant therapies that should be taken into account [81]. Results from a randomized controlled clinical study showed that the implementation of a fast-track protocol improved postoperative clinical recovery and cellular and humoral immunity of patients undergoing esophagectomy for esophageal cancer ( Table 2) [82]. In this context, the implementation of fast-track programs in esophagectomy patients is promising, but the majority of patients included in the studies are relatively healthy patients.…”

Section: Enhanced Recovery After Surgery (Eras)mentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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Section: Enhanced Recovery After Surgery (Eras)mentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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“…В условиях хирургической агрессии ИР обусловлена возрастающей необходимостью в энергетических и пластических веществах для обеспечения функционирования в условиях стресса, а также физиологической стрессовой реакцией, сопровождающейся выбросом катехоламинов, кортизола, глюкагона, гормона роста, способствующих развитию гипергликемии и ИР [13,17]. ИР как адаптационная реакция, регулирующая направленность синтетических и катаболических реакций, может считаться интегральным показателем выраженности хирургического стресса, особенно при торакоабдоминальных операциях, сопровождающихся максимальными изменениями метаболического и иммунного статуса [3,7,15,17,22].…”

Section: Discussionunclassified

“…Одним из способов коррекции ИР стало применение предоперационной метаболической подготовки -преднагрузки углеводами (ПУ), позволяющей снизить частоту послеоперационных осложнений, в том числе гипергликемии, и положительно влияющей на выраженность хирургического стресс-ответа [21,22,25,26,30]. Актуальным представляется изучение влияния ПУ на иммунный и цитокиновый статусы в послеоперационном периоде, недостаточно освещенного в литературе [15,23]. Целью данного рандомизированного сравнительного исследования стало изучение влияния ПУ на выраженность стрессового ответа у пациентов после реконструктивных операций на пищеводе.…”

Section: Introductionunclassified

The Influence of the Preoperative Preload With Carbohydrates Upon Metabolic, Immune and Cytokine Statuses After Reconstructive Esophageal Surgical Interventions

et al. 2018

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The aimof this prospective randomized clinical study was to investigate the role of preoperative carbohydrate admnistration in surgery-induced metabolic, immune and inflammatory reactions after thoracoabdominal operations. At the Surgical department I (B.V. Petrovsky National Research Center of Surgery), we investigated a modulatory role of carbohydrate preload upon surgical stress observed after major thoracoabdominal operations (thoracoscopic and open esophagectomy, retrosternal colonic esophagoplasty) followed by the enhanced recovery protocol. The study was performed in 2014-2017, it included 30 patients, divided into 2 groups. Group A patients (n = 16) received carbohydrates preload (12.5% maltodextrin solution per os or enterally). In patients with dysphagia, the 12.5% dextrose solution was used intravenously in equal volumes. Group B patients didn’t receive any additional preload with carbohydrates. The groups were age- and gendermatched, similar for disease and surgery types. Glucose and insulin levels (with HOMA insulin resistance index, HOMA-IR) were measured before surgery and on day +1, interleukin levels (IL-6, IL-10, IL-8) and index IL-8/IL-10 were assessed before surgery, and on days +1 and +5 after surgery. Cell-mediated immunity was investigated before surgery and on day +5.The stress-induced hyperglycemia (> 7.8 mmol/L) was detected more frequently in group B (50%), than in group A (6%), p = 0.012. Insulin resistance measured by HOMA-IR in group B was detected in 71% of patients and in 25% patients of group A only, p = 0.027. Individual analysis of immune response demonstrated that a trend for immune recovery was detected by the day +5 post-op in the group A. Postoperative levels of IL-6 and IL-10 were lower on day +1 and +5 in group A. Morbidity rates and the terms of hospitalization were similar in both groups. Local postsurgical infections in group A were developed in 6% of the patients vs 35.6% in group B (p = 0.072).In conclusion, a complex study of surgical stress, i.e., metabolic, immune and inflammatory reactions after esophageal surgery has shown that the carbohydrate preload decreased the incidence of postoperative insulin resistance and stress-induced hyperglycemia, being accompanied by lower release of proinflammatory cytokines and provides positive effects upon the patient’s immune system.

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“…1 FTS was first involved in colorectal cancer and effectively reduced postoperative complications and shortened hospital stay. In recent years, FTS has been applied to a variety of surgeries such as bladder cancer, 3 esophageal cancer, 4,5 and autologous breast reconstruction. 6 Gastric cancer (GC) is one of the most common malignancies and the third cause of death from cancer worldwide; it caused 720,000 deaths in 2012.…”

mentioning

confidence: 99%

Fast-Track Surgery Could Improve Postoperative Recovery in Patients with Laparoscopy D2 Gastrectomy

Sha²,

Ren

et al. 2017

International Surgery

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The objective of this study is to evaluate the safety and efficacy of fast track surgery (FTS) management in gastric cancer (GC) with laparoscopy D2 gastrectomy. FTS is the integration of different medical intervention activities during the perioperative period to accelerate the recovery of patients undergoing surgery. It has been used for colorectal cancer. The present study focuses on evaluating FTS in GC with laparoscopy D2 gastrectomy. Seventy-five patients diagnosed with GC between June 2014 and December 2016 were enrolled in this study and were divided into FTS and conventional care groups. All patients received elective standard D2 gastrectomy. The clinical parameters and serum indicators were compared. FTS was associated with shorter postoperative hospital stay (17.17 6 9.27 versus 14.06 6 5.05 days; P ¼ 0.046), shorter time to bowel function return (4.56 6 1.16 versus 3.12 6 0.88 days; P , 0.01), less stress response on postoperative day 1 (108.13 6 40.55 versus 79.01 6 37.10; P , 0.01), and accelerated decrease in serum albumin (30.76 6 4.10 versus 32.56 6 3.20 g/L; P ¼ 0.04) and lymphocyte count (0.78 6 0.34 versus 0.78 6 0.34 g/L; P ¼ 0.016). The postoperative complications, including ileus, anastomotic leakage, and infection, were similar (all P . 0.05). FTS combined with laparoscopy D2 gastrectomy can promote faster postoperative recovery, improve early postoperative nutritional status, and more effectively reduce postoperative stress reaction and is safe and effective for GC patients.

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Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer

Cited by 56 publications

References 25 publications

Nutritional Management of Esophageal Cancer Patients

Nutritional Management of Esophageal Cancer Patients

The Influence of the Preoperative Preload With Carbohydrates Upon Metabolic, Immune and Cytokine Statuses After Reconstructive Esophageal Surgical Interventions

Fast-Track Surgery Could Improve Postoperative Recovery in Patients with Laparoscopy D2 Gastrectomy

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