Effect of fast track surgery on insulin resistance indexes of esophageal cancer patients

Abstract

Objective To investigate the influence of fast track surgery (FTS) on insulin resistance indexes in esophageal cancer patients.Methods A total of 68 esophageal cancer patients receiving radical operation in our hospital from November 2009 to March 2011 were randomly divided into 2 groups by envelope method:FTS group ( n =34) and control group ( n =34 ).The postoperative first passage of gas by annus and defecation,postoperative hospital stay,hospitalization expenditure,and postoperative complications were recorded.Insulin resistance indexes were measured before operation as well as on the 1st,3rd,and 7th postoperative days,including fasting blood-glucose (FBG),fasting insulin (FINS),serum level of interleukin-6 (IL-6),and C-reactive protein (CRP).The insulin resistance index (HOMA-IR) was calculated at the same time points.Results The postoperative time of first passage of gas [ ( 1.91 ± 1.13 ) d vs.(2.95 ± 1.25 ) d,P =0.000 ] and defecation [ ( 3.75 ± 1.54 ) d vs.(4.84 ± 1.76) d,P =0.007] in FTS group were significantly shorter compared with control group,and the total hospitalization expenditure was significantly lower in FTS group [ (3.19±0.42) ten-thousand yuan vs.(3.98 ±0.36) ten-thousand yuan,P =0.000 ].The preoperative insulin resistance indexes showed no signifcant differences between the two groups ( all P ＞ 0.05 ).One day after operation,the levels of log-HOMA-IR (0.97 ± 0.52vs.1.54±0.57,P=0.000),FINS [ (11.87±4.55) μU/ml vs.(17.16±6.90) μU/ml,P=0.000],IL-6[ (124.15±21.39) ng/Lvs.(138.78±23.60) ng/L,P.=0.009],and CRP [ (62.92±14.78) mg/L vs.(71.07 ± 14.51 ) mg/L,P =0.025 ] in FTS group were significantly lower than those in control group.Three days after operation,the levels of log-HOMA-IR (0.86 ± 0.47 vs.1.27 ± 0.58,P =0.002),FINS [ ( 9.56 ± 4.37 )μU/mlvs.(14.91±6.54) μU/ml,P=0.000],IL-6 [ (140.94±25.12) ng/Lvs.(153.89±24.06) ng/L,P=0.035],and CRP [ (138.59 ±21.61) mg/L vs.(153.17 ±25.20) mg/L,P=0.019] in FTS group were significantly lower than those in control group.Seven days after operation,the level of CRP in FTS group was significantly lower than that in control group [ (53.07 ± 15.84 ) mg/L vs.( 61.59 ± 16.28 ) mg/L,P =0.032 ].Conclusion FTS may promote the early recovery of gastrointestinal function,reduce stress reaction and postoperative insulin,thus being conducive to fast rehabilitation of esophageal cancer patients. Key words: Esophageal cancer; Fast track surgery; Insulin resistance; Early enteral nutrition