ERAS combined with preoperative oral nutrition supplement in patients with rectal cancer and its effect on postoperative stress response_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANG Yongcang , NING Zhongliang , ZHENG Wenlin

Department of Gastrointestinal Tumor Surgery, Western District of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Tumor Hospital), Hefei 230001, P. R. China;

Corresponding?author：

WANG Yongcang, Email: wangyongcang2003@163.com

Keywords：

enhanced recovery after surgery; preoperative enteral nutrition; rectal cancer; stress response

DOI：

10.7507/1007-9424.201812074

Video：

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Objective To investigate the effect of enhanced recovery after surgery (ERAS) combined with preoperative oral nutrition supplement (Ensource^TM) in patients with rectal cancer and its effect on postoperative stress response.Methods From January 2018 to August 2018, 80 patients with laparoscopic assisted radical resection of rectal cancer in our hospital were divided into two groups according to different perioperative management. Forty patients who had used enhanced recovery after surgery combine preoperative application of tumor total nutrition formula enteral nutrition solution were as observation group, while other 40 patients who only had used enhanced recovery after surgery in perioperative as control group. We observed the stress response (mean systolic blood pressure, mean diastolic blood pressure, mean heart rate, mean blood oxygen saturation, pain score and fasting blood glucose) at 24 hours after surgery and the time of the first anal exhaust, complication rate, hospitalization time, and hospitalization cost after surgery in both groups. We also compared the early postoperative (on the second day after operation) nutritional status of the two groups like the levels of serum total protein, albumin and proalbumin.Results The mean systolic blood pressure, mean diastolic blood pressure, mean heart rate, mean blood oxygen saturation, pain score and fasting blood glucose of the observation group at 24 hours after surgery were significantly lower than those of the control group (P<0.05), while the total serum protein, albumin and prealbumin concentrations of the observation group were significantly higher than those of the control group on the second day after surgery (P<0.05). Postoperative hospitalization time and hospitalization cost in the observation group were also shorter or less than those in the control group (P<0.05). Compared with the control group, the first postoperative anal exhaust time was earlier and the incidence of postoperative complications was reduced in the observation group, but the difference was not statistically significant (P>0.05).Conclusions ERAS combined with preoperative application of tumor total nutrition formula enteral nutrition fluid (Ensource^TM) can reduce the postoperative stress response and the postoperative complication rate of patients with rectal cancer, and also improve the postoperative nutrition status of patients and promote the rapid recovery of patients after sugery.

Citation： WANG Yongcang, NING Zhongliang, ZHENG Wenlin. ERAS combined with preoperative oral nutrition supplement in patients with rectal cancer and its effect on postoperative stress response. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(4): 438-442. doi: 10.7507/1007-9424.201812074 Copy

1.	Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
2.	王錫山. 中美結直腸癌流行病學特征及防診治策略的對比分析. 中華結直腸疾病電子雜志, 2017, 6(6): 447-453.
3.	趙健, 江志偉. 胃腸論道-加速康復外科論壇會議紀要. 中華胃腸外科雜志, 2017, 20(4): 471-473.
4.	王剛, 江志偉, 鮑揚, 等. 加速康復外科理念指導 116 例結直腸癌手術. 中華胃腸外科雜志, 2010, 13(5): 342-345.
5.	徐棟, 焦裕榮, 丁克峰. 老年結直腸癌患者手術和圍手術期加速康復及術后輔助化療的一體化管理. 中華胃腸外科雜志, 2016, 19(5): 507-510.
6.	王懿, 丁克峰. 快速康復在老年結直腸癌患者圍手術期的臨床研究. 浙江大學碩士學位論文, 2014.
7.	丁杰, 汪灝, 管文賢. 快速康復外科在胃癌手術中應用的 Meta 分析. 中華普通外科雜志, 2015, 30(10): 808-812.
8.	Tanaka R, Lee SW, Kawai M, et al. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer, 2017, 20(5): 861-871.
9.	江志偉, 李寧, 黎介壽. 快速康復外科的概念及臨床意義. 中國實用外科雜志, 2007, 27(2): 131-133.
10.	中華醫學會腸外腸內營養學分會加速康復外科協作組. 結直腸手術應用加速康復外科中國專家共識識. 中華胃腸外科雜志, 2015, 18(8): 785-787.
11.	高向東, 黃彬, 沈燁, 等. 加速康復外科在結直腸癌手術中的效果評價及影響因素分析. 腸外與腸內營養, 2018, 25(4): 228-233.
12.	張亞寧, 任萬良, 趙花. 胃癌患者術后早期腸內營養支持對機體細胞免疫力和腫瘤標志物的影響. 中國腫瘤臨床與康復, 2016, 23(12): 1487-1489.
13.	袁凱濤, 石漢平. 《歐洲臨床營養和代謝學會指南: 外科臨床營養》解讀. 中國實用外科雜志, 2017, 37(10): 1132-1134.
14.	石漢平. 腫瘤營養石漢平 2018 觀點. 第 1 版. 北京: 科學技術文獻出版社, 2018: 1-13328.
15.	Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
16.	林世龍, 諸杜明. 免疫營養物質的研究進展. 中華重癥醫學電子雜志, 2018, 4(1): 26-30.
17.	趙玉沛, 熊利澤. 加速康復外科中國專家共識及路徑管理指南 (2018 版). 中國實用外科雜志, 2018, 38(1): 1-20.
18.	江志偉, 李寧. 結直腸手術應用加速康復外科中國專家共識 (2015 版). 中華胃腸外科雜志, 2015, 18(8): 75-787.
19.	叢明華, 李淑孌, 程國威, 等. 腫瘤全營養配方食品在食管癌放療患者中的應用. 中國腫瘤, 2016, 25(6): 491-494.
20.	Borek P, Chmielewski M, Ma?gorzewicz S, et al. Analysis of outcomes of the NRS 2002 in patients hospitalized in nephrology wards. Nutrients, 2017, 9(287): 1-8.
21.	Rom O, Reznick AZ. The stress reaction: A historical perspective. Adv Exp Med Biol, 2016, 905: 1-4.
22.	?sapay G, ?sapay K. Stress and fertility. Orv Hetil, 2015, 156(35): 1430-1434.
23.	王帥, 邱遠, 江恩來, 等. 從手術應激的角度看加速康復外科. 中國普外基礎與臨床雜志, 2018, 25(7): 878-881.
24.	Khoo B, Boshier PR, Freethy A, et al. Redefining the stress cortisol response to surgery. Clin Endocrinol (Oxf), 2017, 87(5): 451-458.
25.	Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS^?) society recommendations. Clin Nutr, 2012, 31(6): 801-816.
26.	Benoist S, Brouquet A. Nutritional assessment and screening for malnutrition. J Visc Surg, 2015, 152(Suppl 1): S3-S7.
27.	Ryan AM, Power DG, Daly L, et al. Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc, 2016, 75(2): 199-211.
28.	賈震易, 秦環龍. 胃腸腫瘤患者營養風險與營養支持調查分析. 中國普外基礎與臨床雜志, 2011, 18(12): 1254-1258.
29.	Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr, 2017, 36(5): 1187-1196.

1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
2. 王錫山. 中美結直腸癌流行病學特征及防診治策略的對比分析. 中華結直腸疾病電子雜志, 2017, 6(6): 447-453.
3. 趙健, 江志偉. 胃腸論道-加速康復外科論壇會議紀要. 中華胃腸外科雜志, 2017, 20(4): 471-473.
4. 王剛, 江志偉, 鮑揚, 等. 加速康復外科理念指導 116 例結直腸癌手術. 中華胃腸外科雜志, 2010, 13(5): 342-345.
5. 徐棟, 焦裕榮, 丁克峰. 老年結直腸癌患者手術和圍手術期加速康復及術后輔助化療的一體化管理. 中華胃腸外科雜志, 2016, 19(5): 507-510.
6. 王懿, 丁克峰. 快速康復在老年結直腸癌患者圍手術期的臨床研究. 浙江大學碩士學位論文, 2014.
7. 丁杰, 汪灝, 管文賢. 快速康復外科在胃癌手術中應用的 Meta 分析. 中華普通外科雜志, 2015, 30(10): 808-812.
8. Tanaka R, Lee SW, Kawai M, et al. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer, 2017, 20(5): 861-871.
9. 江志偉, 李寧, 黎介壽. 快速康復外科的概念及臨床意義. 中國實用外科雜志, 2007, 27(2): 131-133.
10. 中華醫學會腸外腸內營養學分會加速康復外科協作組. 結直腸手術應用加速康復外科中國專家共識識. 中華胃腸外科雜志, 2015, 18(8): 785-787.
11. 高向東, 黃彬, 沈燁, 等. 加速康復外科在結直腸癌手術中的效果評價及影響因素分析. 腸外與腸內營養, 2018, 25(4): 228-233.
12. 張亞寧, 任萬良, 趙花. 胃癌患者術后早期腸內營養支持對機體細胞免疫力和腫瘤標志物的影響. 中國腫瘤臨床與康復, 2016, 23(12): 1487-1489.
13. 袁凱濤, 石漢平. 《歐洲臨床營養和代謝學會指南: 外科臨床營養》解讀. 中國實用外科雜志, 2017, 37(10): 1132-1134.
14. 石漢平. 腫瘤營養石漢平 2018 觀點. 第 1 版. 北京: 科學技術文獻出版社, 2018: 1-13328.
15. Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
16. 林世龍, 諸杜明. 免疫營養物質的研究進展. 中華重癥醫學電子雜志, 2018, 4(1): 26-30.
17. 趙玉沛, 熊利澤. 加速康復外科中國專家共識及路徑管理指南 (2018 版). 中國實用外科雜志, 2018, 38(1): 1-20.
18. 江志偉, 李寧. 結直腸手術應用加速康復外科中國專家共識 (2015 版). 中華胃腸外科雜志, 2015, 18(8): 75-787.
19. 叢明華, 李淑孌, 程國威, 等. 腫瘤全營養配方食品在食管癌放療患者中的應用. 中國腫瘤, 2016, 25(6): 491-494.
20. Borek P, Chmielewski M, Ma?gorzewicz S, et al. Analysis of outcomes of the NRS 2002 in patients hospitalized in nephrology wards. Nutrients, 2017, 9(287): 1-8.
21. Rom O, Reznick AZ. The stress reaction: A historical perspective. Adv Exp Med Biol, 2016, 905: 1-4.
22. ?sapay G, ?sapay K. Stress and fertility. Orv Hetil, 2015, 156(35): 1430-1434.
23. 王帥, 邱遠, 江恩來, 等. 從手術應激的角度看加速康復外科. 中國普外基礎與臨床雜志, 2018, 25(7): 878-881.
24. Khoo B, Boshier PR, Freethy A, et al. Redefining the stress cortisol response to surgery. Clin Endocrinol (Oxf), 2017, 87(5): 451-458.
25. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS^?) society recommendations. Clin Nutr, 2012, 31(6): 801-816.
26. Benoist S, Brouquet A. Nutritional assessment and screening for malnutrition. J Visc Surg, 2015, 152(Suppl 1): S3-S7.
27. Ryan AM, Power DG, Daly L, et al. Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc, 2016, 75(2): 199-211.
28. 賈震易, 秦環龍. 胃腸腫瘤患者營養風險與營養支持調查分析. 中國普外基礎與臨床雜志, 2011, 18(12): 1254-1258.
29. Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr, 2017, 36(5): 1187-1196.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

ERAS combined with preoperative oral nutrition supplement in patients with rectal cancer and its effect on postoperative stress response

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