Effect of postoperative early enteral nutrition on the recovery of humoral immune function in patients with colorectal carcinoma undergoing elective resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of postoperative early oral feeding on humoral immune function and clinical outcome in colorectal cancer patients.</p><p><b>METHODS</b>Seventy patients with colorectal carcinoma requiring elective colorectal resection were prospectively enrolled and randomized into two groups: early oral feeding group(n=35) and conventional oral feeding group(n=35). The patients in early oral feeding group were started on oral feeding within 12 hours after operation, while patients in conventional group were started on oral feeding after the postoperative first passage of flatus. Postoperative parameters of clinic and humeral immune function were compared between two groups.</p><p><b>RESULTS</b>Sixty-two patients eventually completed the study, including 32 cases in early oral feeding group and 30 cases in conventional oral feeding group. The average time to first passage of flatus[(2±1) d vs. (4±2) d, P<0.01], the first passage of stool [(3.8±1.6) d vs. (6.4±2.5) d, P<0.01], resumption of regular diet [(4±2) d vs. (8.2±2.2) d, P<0.01] and the postoperative hospital stay [(6±1) d vs. (11.7±3.8) d, P<0.01] were significantly shorter in early oral feeding group as compared to conventional oral feeding group. Significantly faster recovery of postoperative humoral immunity was found. Plasma levels of globulin [(24.1±2.4) g/L vs. (22.1±3.3) g/L, P<0.05], immunoglobulin G[(10.8±2.4) g/L vs. (8.7±2.1) g/L, P<0.01] and complement 4 [(0.24±0.09) g/L vs. (0.17±0.05) g/L, P<0.05] on postoperative day 3 were higher in early oral feeding group as compared to conventional oral feeding group.</p><p><b>CONCLUSION</b>Application of postoperative early oral feeding in patients undergoing elective colorectal resection is safe and effective, which can lead to faster recovery of postoperative humoral immune function and bowel function, and shorter postoperative hospital stay.</p>

Fast track surgery accelerates the postoperative rehabilitation and recovery of insulin sensitivity in elective operation for colorectal carcinoma: a randomized controlled clinical trial / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of fast track surgery on postoperative insulin sensitivity on the basis of clinical benefits in patients undergoing elective open colorectal resection.</p><p><b>METHODS</b>During May 2008 to December 2008, Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters, stress markers and insulin sensitivity were evaluated in both groups.</p><p><b>RESULTS</b>The 62 patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. The speed of recovery of postoperative insulin sensitivity on 7 days postoperative in the fast-track group (97% ± 9%) was significantly faster than the conventional care group (88.5% ± 9.0%, t = 2.552, P = 0.016). The hospitalization days in the fast-track group was 6 days (M(50)), and it was significantly shorter than the conventional care group ((11.7 ± 3.8) days, Z = 4.360, P = 0.000). The time of recovery of bowel function were faster in the fast-track group (time to pass flatus was 2 days (M(50))) than the conventional care group (4 days, Z = 3.976, P = 0.000). The Infectious complication rate in the fast-track group (2/32) is lower than the other group (8/30, P = 0.040).</p><p><b>CONCLUSION</b>Fast track surgery accelerates recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a lower rate of postoperative infectious complications and a shorter length of postoperative hospital stay.</p>

Fast track surgery accelerates the recovery of postoperative insulin sensitivity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.</p><p><b>METHODS</b>Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively.</p><p><b>RESULTS</b>Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.</p><p><b>CONCLUSION</b>Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.</p>

Effects of preoperative oral glucose on perioperative insulin resistance and plasma proteins of intestinal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of oral intake of glucose solution before surgery on the pH at the lower esophagus, perioperative blood glucose level, and plasmic protein in patients undergoing radical resection for colorectal cancer.</p><p><b>METHODS</b>Between January 2008 and December 2008, 60 patients undergoing radical surgery for colorectal cancer were enrolled and randomized into three groups using the table of random digits. Four patients were withdrawn from the study. Patients in group A (n=19) were given 800 ml of 12.5% glucose solution for oral intake the night before surgery, and 200 ml two hours before surgery. Patients in group B (n=19) were given distilled water instead of glucose. Patients in group C (n=18) were asked to fast for 8-12 hours before operation. Combined general and epidural anesthesia was used. pH at the lower esophagus was monitored during intubation and extubation. Albumin, transferrin, prealbumin, insulin, and fasting blood glucose were measured before surgery and at postoperative day 1, 3, and 7.</p><p><b>RESULTS</b>pH at the lower esophagus was 8.05±0.43 in group A, 7.98±0.41 in group B, and 7.94±0.41 in group C. There were no perioperative acid regurgitations (P>0.05). Serum insulin in group A at postoperative day 1 was (16.32±16.11) μU/L, which was significantly lower than that in group B (30.65±41.74) μU/L and group C (34.01±52.91) μU/L. Log HOMA-IR in group A at postoperative day 1 was significantly lower than that in group B and group C (0.49±0.35 vs. 0.59±0.56 and 0.60±0.63, P<0.05). Transferrin in group C at postoperative day 3 and 7 was significantly lower than that in the other two groups, as was albumin at postoperative day 3 (P<0.05).</p><p><b>CONCLUSION</b>Oral liquid intake 2 hours before surgery is not associated with increased risk of regurgitation or aspiration during intubation and extubation, and may glucose solution intake reduce insulin resistance and protein degradation after colorectal surgery.</p>

Associations of E-cadherin gene (CDH1) and hereditary gastric cancer in China / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the protein expression, methylation promoter, somatic and germ-line mutations of E-cadherin gene (CDH1) in hereditary gastric cancer in China and to investigate its possible roles.</p><p><b>METHODS</b>Eight probands diagnosed with ICG-HGC criterion were enrolled in our database from June 1994 to October 2007. Tumor tissues were detected for CDH1 expression by using immunohistochemistry (IHC) methods. CDH1 DNA sequencing was performed for all its 16 exons both in tumor and normal tissues of the same patients to detect somatic and germ-line mutations. Methylation promoter study was performed by using specific primers and polymerase chain reaction (PCR) methods.</p><p><b>RESULTS</b>IHC analysis confirmed that the CDH1 expression was negative in 7 probands and downregulated in the other on proband. Six mutations in five probands were found with DNA sequencing: two silent mutations and four missense mutations. All six mutations were absent in normal tissues, thereby excluded its presence in germ-line cells. Both DNA missense mutations and gene silencing through promoter methylation was found in 4 probands. Two probands has only promoter methylation and one proband had only silent mutation. No DNA missense mutations or promoter methylation was found in one proband.</p><p><b>CONCLUSIONS</b>CDH1 gene germ-line mutations are relatively rare in hereditary gastric cancer in China, and whereas CDH1 somatic mutations and promoter methylation synergistically induce CDH1 downregulation in these patients.</p>

Study on the clinicopathological characteristics and pattern of lymph node metastasis in patients with gastric remnant cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate clinicopathological characteristics and the pattern of lymph node metastasis of patients with gastric remnant cancer.</p><p><b>METHODS</b>The data of the clinicopathological characteristics and the pattern of lymph node metastasis in 56 patients with gastric remnant cancer treated from March 1994 to December 2008 was investigated and compared with those in 1171 patients with primary gastric cancer treated over the same period.</p><p><b>RESULTS</b>Fifty-six patients (4.6%) with gastric remnant cancer were enrolled in this study during the period. Compared with patients with primary gastric cancer, the age of cancer onset was older [(64.3+/-9.0) vs. (58.3+/-12.6) yrs], lymph node metastasis rate was higher (31.8% vs. 25.5%), Borrmann's classification was later and neighbor organ resection rate was higher (57.1% vs. 26.4%) in patients with gastric remnant cancer; the differences were all significant (chi2=18.800, 11.679, 9.177, 25.190; P<0.05). Patients with gastric remnant cancer who underwent lymph node dissection tended to have a higher incidence of No.10 (splenic hilar lymph node) and No.11 (splenic artery lymph node) group lymph node metastasis than those in primary gastric cancer (chi2=5.558, 6.099; P<0.05). In contrast, patients with primary gastric cancer had a higher incidence of No. 2 (left cardiac lymph node), No.3 (lesser curvature lymph node) and No.8 (common hepatic artery lymph node) group lymph node metastasis than those in gastric remnant cancer (chi2=15.508, 6.003, 4.084; P<0.05). The jejunal mesentery lymph node metastasis was 24.0% (6/25) in patients with gastric remnant cancer and the peripheral connective tissue infiltration rate was 14.3% (8/56).</p><p><b>CONCLUSIONS</b>It suggested that patients with gastric remnant cancer has different clinicopathologic characteristics and the pattern of lymph node metastasis from those with primary gastric cancer. D2 lymph node dissection of proximate gastric cancer and jejunal mesentery lymph node dissection should be the standard operation for these patients; but combined neighboring organ resection should be taken into consideration.</p>

Early operation for fulminant acute pancreatitis: a possible way to decrease mortality / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although the indication and the timing for surgery in fulminant acute pancreatitis (FAP) are still controversial, our experience of surgical treatment for fulminant acute pancreatitis may help improve the outcome for patients.</p><p><b>METHODS</b>The clinical data of twenty-six patients with FAP from January 1, 2001 to October 1, 2005 were analyzed. The diagnostic criteria fitted the 2007 Guidelines for the Management of Severe Acute Pancreatitis by the Chinese Medical Association.</p><p><b>RESULTS</b>Twenty-six patients with FAP received surgical debridement, with a mortality rate of 42.3% (11/26). The postoperative mortalities in the > 72 hour operation group and the <or= 72 hour operation group were highly significantly different (7/8 vs 22.2% (4/18), respectively).</p><p><b>CONCLUSIONS</b>Early surgery may reduce the intraabdominal pressure and prevent the deterioration of FAP. An operation within 72 hours from the onset of symptoms might decrease the mortality of the disease.</p>