Laparoscopic surgery contributes more to nutritional and immunologic recovery than fast-track care in colorectal cancer

Dong Xu, Jun Li, Yongmao Song, Jiaojiao Zhou, Fangfang Sun, Jianwei Wang, Yin Duan, Yeting Hu, Yue Liu, Xiaochen Wang, Lifeng Sun, Linshan Wu, Kefeng Ding, Dong Xu, Jun Li, Yongmao Song, Jiaojiao Zhou, Fangfang Sun, Jianwei Wang, Yin Duan, Yeting Hu, Yue Liu, Xiaochen Wang, Lifeng Sun, Linshan Wu, Kefeng Ding

Abstract

Background: Many clinical trials had repeatedly shown that fast-track perioperative care and laparoscopic surgery are both preferred in the treatment of colorectal cancer. But few studies were designed to explore the diverse biochemical impacts of the two counterparts on human immunologic and nutritional status.

Methods: Ninety-two cases of colorectal cancer patients meeting the inclusion criteria were randomized to four groups: laparoscopy with fast-track treatment (LAFT); open surgery with fast-track treatment (OSFT); laparoscopy with conventional treatment (LAC); open surgery with conventional treatment (OSC). Peripheral blood tests including nutritional factors (albumin, prealbumin, and transferrin), humoral immunologic factors (IgG, IgM, and IgA), and cellular immunologic factors (T and NK cells) were evaluated. Blood samples were collected preoperatively (baseline) and 12 and 96 h after surgery (indicated as POH12 and POH96, respectively).

Results: Albumin, transferrin, prealbumin, and IgG levels were the highest in the LAFT group for both POH12 and POH96 time intervals. Repeated measures (two-way ANOVA) indicated that the difference of albumin, transferrin, and IgG level were attributed to surgery type (P < 0.05) and not perioperative treatment (P > 0.05). Only in the laparoscopy-included groups, the relative albumin and IgG levels of POH96 were obviously higher than that of POH12.

Conclusion: Laparoscopic surgery accelerated postoperative nutrition and immune levels rising again while fast-track treatment retarded the drop of postoperative nutrition and immune levels. Laparoscopic surgery might play a more important role than fast-track treatment in the earlier postoperative recovery of nutritional and immunologic status. Combined laparoscopic surgery with fast-track treatment provided best postoperative recovery of nutrition and immune status. These results should be further compared with the clinical outcomes of our FTMDT trial (clinicaltrials.gov: NCT01080547).

Figures

Figure 1
Figure 1
Study flow.
Figure 2
Figure 2
Nutritional status of different time intervals in the four groups: albumin (A), TRF (B), prealbumin (C).
Figure 3
Figure 3
Humoral immunity status of different time intervals in the four groups: IgG (A), IgA (B), IgM (C).
Figure 4
Figure 4
T (A) and NK cell (B) counts of different time intervals in four groups.

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Source: PubMed

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