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<p><b>OBJECTIVE</b>To investigate the impact of preoperative oral liquid carbohydrate on postoperative insulin resistance (IR) in gastric cancer patients undergoing elective resection, and to examine the association of IR index (homeostasis model assessment, HOMA-IR) with tumor necrosis factor-α (TNF-α).</p><p><b>METHODS</b>Between January 2013 and September 2013, 35 patients undergoing elective resection for gastric cancer were prospectively enrolled and randomized into two groups. Patients in trial group (n=18) received oral 500 ml of 10% glucose solution two hours before surgery. Patients in control group (n=17) were asked to fast for 8-12 hours before operation. About 300 mg of rectus abdominis and subcutaneous fatty tissues was removed before the closure of abdominal wall. Blood samples were collected to measure the serum concentration of TNF-α with double antibody sandwich ELISA in perioperative period (3-hour before operation, end of operation, 1-day and 3-day after operation). HOMA-IR was calculated on preoperative 3-hour and postoperative 1-day. Western blotting was used to detect protein expression of TNF-α. Correlation of HOMA-IR with TNF-α was examined.</p><p><b>RESULTS</b>HOMA-IR on the first day after surgery was not different from that at 3-hour before surgery in trial group (P=0.090), which was significantly lower than that in control group (P=0.000). In trial group, serum TNF-α at the end of operation was higher than that at 3-hour before surgery, which declined rapidly on the first day after surgery and had no significant difference compared with that on the third day after surgery. In control group, serum TNF-α at the end of operation was also higher than that before surgery, which rose to the peak on the first day after surgery and was still higher than that at 3-hour before surgery. The TNF-α protein expression in muscle tissues of trial group was higher than that of control group (P=0.001), while no significant difference was observed between two groups in adipose tissues (P=0.987). Correlation analysis showed that HOMA-IR was positively correlated with TNF-α on the first day after surgery (r=0.832, P=0.000).</p><p><b>CONCLUSION</b>Oral intake of liquid carbohydrate 2 hours before surgery can reduce the level of TNF-α, which is likely to improve the postoperative insulin resistance.</p>
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Humans , Carbohydrates , Fasting , Insulin Resistance , Postoperative Period , Prospective Studies , Stomach Neoplasms , Tumor Necrosis Factor-alphaABSTRACT
Objective To investigate the effect of oral intake of 10%glucose solution before surgery on the perioperative safety and postoperative insulin resistance in patients undergoing resection for gastric cancer. Methods Between March 2012 and December 2012,36 patients undergoing elective resection for gastric cancer were enrolled and randomized into three groups. Patients in group A were given 500ml of 10%glucose solution for oral intake two hours before surgery. Patients in the group B were given distilled water instead of glucose. Patients in the group C were asked to fast for 8 hours before operation. Patient′s wellbeing scores on a visual analogue scales (VAS) were recorded. Blood samples were collected to measure. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) according to the level of blood glucose and the serum concentration of insulin. The gastric residues before anesthesia and the time of exhaustion and defecation were also recorded. Results The gastric residues were not increased significantly after the intake of 10%glucose solution (P > 0.05). Intake of 10% glucose solution before surgery relieved thirst and hunger (P 0.05). The HOMA-IR levels postoperative immediately, on the first day and the third day after surgery were lower in group A than that of group B and group C (P < 0.05), but the ISI levels were higher significantly (P < 0.01). Conclusion Intake of 10%glucose solution 2 hours before surgery for gastric cancer is be safe , which can relieve preoperative thirst and hunger, and improve postoperative insulin resistance.
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Objective To explore the optimum sentinel lymph node (SLN) mapping method in gastric cancer. Methods The clinical data of 59 patients who were confirmed with gastric cancer at Guangzhou General Hospital of Guangzhou Military Command from January 2004 to August 2008 were retrospectively analysed. Patent blue V dye was used in 20 patients (group A), technetium-99m sulfur colloid was used in 20 patients (group B),and a combination of patent blue V dye and technetium-99m sulfur colloid were used in 19 patients (group C).The number of SLNs detected, and accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were analysed by t test and chi-square test. Results The numbers of SLNs detected in groups A, B and C were 38 (1.9 per case), 31 (1.6 per case) and 56 (2.9 per case), respectively. In group C, 46 SLNs were screened out by patent blue V dye and technetium-99m sulfur colloid simultaneously, six SLNs were only detected by patent blue V dye and four only by technetium-99m sulfur colloid. There was a significant difference in the number of SLNs detected among the three groups (t = 4.35, P ＜ 0. 05 ). The number of SLNs detected in group C was significantly greater than that in groups A and B (t = 4. 21, 3. 54, P ＜ 0.05 ). The accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were 95% (19/20) and 5% (1/20) in group A, 90% (18/20) and 10% (2/20) in group B, and 100% (19/19) and 0 in group C. The accuracy was significantly higher (x2 = 163.01, P ＜ 0.05) and the false-negative rate was significantly lower in group C compared with those in groups A and B (x2 = 170. 14, P ＜ 0. 05). Conclusion A combination of dye and radioactive tracer is a favorable method for detecting SLNs in gastric cancer.
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Objective: To study the feasibility of fast-track surgery in colorectal surgery. Methods: 61 patients with elective colorectal operation were divided randomly into experimental group (n=31)and control group(n=30), which were treated with fast-track surgery and traditional methods respectively. The data of stress and recovery after surgery were evaluated. Results: Compared to routine methods, the fast-track surgery can lighten stress, accelerate recovery and reduce the rate of overall complication after surgery. Conclusions: Fast-track surgery including intervention during perioperative period is safe and effective in colorectal surgery, significantly lightening stress and improving recovery in patients after colorectal surgery.
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0.05).From ≤40 years to 71～80 years, the proportion of proximal colon cancers remained stable, distal colon cancers increased from 14.7% to 26.9%, and rectal cancers decreasd from 58.6% to 47.8% (P
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Objective To study the relationship between anatomic site distribution and clinical pathologic characteristics of colorectal cancer(CRC). Methods Clinical data were collected from 790 patients in Nanfang Hospital admitted from 1990 to 1999. Results Mucous adenocarcinoma accounted for 26 5% in proximal colon, 10 1% in distal colon and 9 4% in rectum; Poor differentiation cancer accounted for 14 5%,5 7% and 10 0% respectively, and 85 3%,75 3% and 77 1% was in advanced stage of cancer (Dukes B, C and D) in proximal, distal colon and rectum respectively. There was significant difference( P 0 05) in pathologic type and tumor′s stage. Conclusions Proximal colon cancer has some significantly different characteristics from distal colon or rectal cancer, with more mucous adenocarcinoma, poor differentiation and later tumor stage.