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Supportive Care in Cancer

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01-02-2014 | Original Article

Fast-track surgery improves postoperative clinical recovery and reduces postoperative insulin resistance after esophagectomy for esophageal cancer

Authors: Guibin Zhao, Shouqiang Cao, Jian Cui

Published in: Supportive Care in Cancer | Issue 2/2014

Abstract

Purpose

This study aims to investigate the influence of fast-track surgery (FTS) on insulin resistance indicators in a prospective randomized, controlled clinical trial in esophageal cancer patients.

Methods

Between November 2009 and March 2011, 34 patients underwent the FTS pathway, and 34 patients underwent the conventional pathway after esophagectomy in our department. The times to postoperative flatus and defecation, duration of postoperative hospital stay, hospitalization expenditures, and postoperative complications were recorded. Insulin resistance indicators were measured before operation as well as on the 1st, 3rd, and 7th postoperative days (PODs), including serum levels of fasting blood glucose (FBG), fasting insulin (FINS), interleukin-6 (IL-6), and C-reactive protein (CRP) in patients of both groups. The insulin resistance index (homeostasis model assessment of insulin resistance (HOMA-IR)) was calculated at each time point.

Results

We found a significantly shorter postoperative hospital stay and faster return of gastrointestinal function in patients who underwent FTS (P < 0.01). In addition, the total hospitalization expenditure was significantly lower in the FTS group (P < 0.01). The preoperative insulin resistance indicators showed no significant differences between the two groups. On PODs 1 and 3, the levels of log-HOMA-IR, FINS, IL-6, and CRP in the FTS group were significantly lower than those in the control group (all P < 0.05). On POD 7, the CRP level in the FTS group was significantly lower than that in the control group (P < 0.05).

Conclusions

FTS promotes early recovery of gastrointestinal function and reduces stress reaction and postoperative insulin resistance after esophagectomy for esophageal cancer.

Andersen HK, Lewis SJ, Thomas S (2006) Early enteral nutrition within 24 h of colorectal surgery versus later commencement of feeding for postoperative complications Cochrane Database Syst Rev: CD004080

Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN, Daley J, Henderson WG, Krasnicka B, Khuri SF (2003) Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 75:217–222, Discussion 222PubMedCrossRef

Bastard JP, Jardel C, Bruckert E, Blondy P, Capeau J, Laville M, Vidal H, Hainque B (2000) Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab 85:3338–3342PubMedCrossRef

Bastard JP, Maachi M, Van Nhieu JT, Jardel C, Bruckert E, Grimaldi A, Robert JJ, Capeau J, Hainque B (2002) Adipose tissue IL-6 content correlates with resistance to insulin activation of glucose uptake both in vivo and in vitro. J Clin Endocrinol Metab 87:2084–2089PubMedCrossRef

Black PR, Brooks DC, Bessey PQ, Wolfe RR, Wilmore DW (1982) Mechanisms of insulin resistance following injury. Ann Surg 196:420–435PubMedCrossRef

Cao S, Zhao G, Cui J, Dong Q, Qi S, Xin Y, Shen B, Guo Q (2013) Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer 21:707–714PubMedCrossRef

Cerfolio RJ, Bryant AS, Bass CS, Alexander JR, Bartolucci AA (2004) Fast tracking after Ivor Lewis esophagogastrectomy. Chest 126:1187–1194PubMedCrossRef

Daltroy LH, Morlino CI, Eaton HM, Poss R, Liang MH (1998) Preoperative education for total hip and knee replacement patients. Arthritis Care Res 11:469–478PubMedCrossRef

Daryaei P, Vaghef Davari F, Mir M, Harirchi I, Salmasian H (2009) Omission of nasogastric tube application in postoperative care of esophagectomy. World J Surg 33:773–777PubMedCrossRef

10.

Greisen J, Juhl CB, Grofte T, Vilstrup H, Jensen TS, Schmitz O (2001) Acute pain induces insulin resistance in humans. Anesthesiology 95:578–584PubMedCrossRef

11.

Jiang K, Cheng L, Wang JJ, Li JS, Nie J (2009) Fast track clinical pathway implications in esophagogastrectomy. World J Gastroenterol 15:496–501PubMedCrossRef

12.

Jianjun Q, Yin L, Wenqun X, Ming Y, Qingfeng J (2012) Fast track program for esophagectomy patients. Thorac Cancer 3:55–59CrossRef

13.

Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641PubMedCrossRef

14.

Lewis SJ, Andersen HK, Thomas S (2009) Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 13:569–575PubMedCrossRef

15.

Ljungqvist O, Nygren J, Thorell A (2002) Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proc Nutr Soc 61:329–336PubMedCrossRef

16.

Neal JM, Wilcox RT, Allen HW, Low DE (2003) Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction. Reg Anesth Pain Med 28:328–334PubMed

17.

Nguyen NT, Slone J, Wooldridge J, Smith BR, Reavis KM, Hoyt D (2009) Minimally invasive esophagectomy without the use of postoperative nasogastric tube decompression. Am Surg 75:929–931PubMed

18.

Nygren J, Soop M, Thorell A, Sree Nair K, Ljungqvist O (1999) Preoperative oral carbohydrates and postoperative insulin resistance. Clin Nutr 18:117–120PubMedCrossRef

19.

Ridker PM (2003) Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 107:363–369PubMedCrossRef

20.

Sagar S, Harland P, Shields R (1979) Early postoperative feeding with elemental diet. Br Med J 1:293–295PubMedCentralPubMedCrossRef

21.

Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T (2010) The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab 95:4338–4344PubMedCrossRef

22.

Thorell A, Loftenius A, Andersson B, Ljungqvist O (1996) Postoperative insulin resistance and circulating concentrations of stress hormones and cytokines. Clin Nutr 15:75–79PubMedCrossRef

23.

Thorell A, Nygren J, Ljungqvist O (1999) Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care 2:69–78PubMedCrossRef

24.

Tsubo T, Kudo T, Matsuki A, Oyama T (1990) Decreased glucose utilization during prolonged anaesthesia and surgery. Can J Anaesth 37:645–649PubMedCrossRef

25.

Uchida I, Asoh T, Shirasaka C, Tsuji H (1988) Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique. Br J Surg 75:557–562PubMedCrossRef

26.

Vaithiswaran V, Srinivasan K, Kadambari D (2008) Effect of early enteral feeding after upper gastrointestinal surgery. Trop Gastroenterol 29:91–94PubMed

27.

Yagci G, Can MF, Ozturk E, Dag B, Ozgurtas T, Cosar A, Tufan T (2008) Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial. Nutrition 24:212–216PubMedCrossRef

28.

Yendamuri S, Fulda GJ, Tinkoff GH (2003) Admission hyperglycemia as a prognostic indicator in trauma. J Trauma 55:33–38PubMedCrossRef

29.

Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V (2000) Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link? Atherosclerosis 148:209–214PubMedCrossRef

Title: Fast-track surgery improves postoperative clinical recovery and reduces postoperative insulin resistance after esophagectomy for esophageal cancer
Authors: Guibin Zhao
Shouqiang Cao
Jian Cui
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 2/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1979-0

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Abstract

Purpose

Methods

Results

Conclusions

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