Abstract
sBackgroundMany 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.MethodsNinety-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).ResultsAlbumin, 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.ConclusionLaparoscopic 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).
Highlights
Many clinical trials had repeatedly shown that fast-track perioperative care and laparoscopic surgery are both preferred in the treatment of colorectal cancer
Twenty-one patients were randomized for laparoscopy with fast-track treatment (LAFT) group, for open surgery with fast track treatment (OSFT), for laparoscopy with conventional treatment (LAC), and 20 for open surgery with conventional treatment (OSC)
Cellular immunity status T and NK cell counts of POH 96 (Figure 4A, B) were higher in laparoscopy-included groups (LAC and LAFT) than that in open surgery-included groups
Summary
Many clinical trials had repeatedly shown that fast-track perioperative care and laparoscopic surgery are both preferred in the treatment of colorectal cancer. In the past few years, the introduction of two feasible treatments, the fast-track recovery program after surgery [1] and laparoscopic surgery, has been proved to significantly benefit patients. According to the results from LAFA trial, the optimal combination of treatment for colon cancer patients is a laparoscopic surgery combined with a fast-track perioperative care [6,7]. The EnROL trial indicated laparoscopic surgery confers a significant clinical benefit versus open surgery embedded in an enhanced recovery program [8]. While direction 2 followed closely the detailed and biochemical impacts of the combined treatment of laparoscopic colostomy and fast-track perioperative treatments Direction 1 concerned more about the clinical parameters of patients such as hospitalization stay, return of bowel movement, etc. while direction 2 followed closely the detailed and biochemical impacts of the combined treatment of laparoscopic colostomy and fast-track perioperative treatments
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