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Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer.

Chen L, Sun L, Lang Y, Wu J, Yao L, Ning J, Zhang J, Xu S - BMC Cancer (2016)

Bottom Line: We found implementation of FTS pathway decreases postoperative length of stay and hospital charges (P < 0.05).In addition, inflammatory reactions, based on IL-6 and CRP levels, were less intense following FTS pathway compared to conventional pathway on POD1 and POD3 (P < 0.05).On POD1 and POD3, the levels of IgG, IgA, CD3 lymphocytes, CD4 lymphocytes and the CD4/CD8 ratio in FTS group were significantly higher than those in control group (All P < 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.

ABSTRACT

Background: Our aim was to investigate the influence of FTS on human cellular and humoral immunity using a randomized controlled clinical study in esophageal cancer patients.

Methods: Between October 2013 and December 2014, 276 patients with esophageal cancer in our department were enrolled in the study. The patients were randomized into two groups: FTS pathway group and conventional pathway group. The postoperative hospital stay, hospitalization expenditure, and postoperative complications were recorded. The markers of inflammatory and immune function were measured before operation as well as on the 1st, 3rd, and 7th postoperative days (POD), including serum level of interleukin-6 (IL-6), C-reactive protein (CRP), serum globulin, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA) and lymphocyte subpopulations (CD3 lymphocytes, CD4 lymphocytes, CD8 lymphocytes and the CD4/CD8 ratio) in the patients between the two groups.

Results: In all, 260 patients completed the study: 128 in the FTS group and 132 in the conventional group. We found implementation of FTS pathway decreases postoperative length of stay and hospital charges (P < 0.05). In addition, inflammatory reactions, based on IL-6 and CRP levels, were less intense following FTS pathway compared to conventional pathway on POD1 and POD3 (P < 0.05). On POD1 and POD3, the levels of IgG, IgA, CD3 lymphocytes, CD4 lymphocytes and the CD4/CD8 ratio in FTS group were significantly higher than those in control group (All P < 0.05). However, there were no differences in the level of IgM and CD8 lymphocytes between the two groups.

Conclusions: FTS improves postoperative clinical recovery and effectively inhibited release of inflammatory factors via the immune system after esophagectomy for esophageal cancer.

Trial registration: ChiCTR-TRC-13003562 , the date of registration: August 29, 2013.

No MeSH data available.


Related in: MedlinePlus

Patient flow throughout the study
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Fig1: Patient flow throughout the study

Mentions: Ten patients in the FTS group and 6 patients in the conventional group failed to undergo FTS and conventional pathway. Most of them did not undergo esophagectomy as expected. The final study population included 260 patients (Fig. 1). The relevant characteristics of patients and the types of surgery are listed in Table 1. Gastroscope and barium meal of the upper gastrointestinal tract were systematically performed for tumors before operations. All patients underwent further work-up to assess the medical operability. This included evaluation of pulmonary and cardiac function, cervical and abdominal ultrasonography, chest computed tomography, and hematological examinations.Fig. 1


Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer.

Chen L, Sun L, Lang Y, Wu J, Yao L, Ning J, Zhang J, Xu S - BMC Cancer (2016)

Patient flow throughout the study
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940721&req=5

Fig1: Patient flow throughout the study
Mentions: Ten patients in the FTS group and 6 patients in the conventional group failed to undergo FTS and conventional pathway. Most of them did not undergo esophagectomy as expected. The final study population included 260 patients (Fig. 1). The relevant characteristics of patients and the types of surgery are listed in Table 1. Gastroscope and barium meal of the upper gastrointestinal tract were systematically performed for tumors before operations. All patients underwent further work-up to assess the medical operability. This included evaluation of pulmonary and cardiac function, cervical and abdominal ultrasonography, chest computed tomography, and hematological examinations.Fig. 1

Bottom Line: We found implementation of FTS pathway decreases postoperative length of stay and hospital charges (P < 0.05).In addition, inflammatory reactions, based on IL-6 and CRP levels, were less intense following FTS pathway compared to conventional pathway on POD1 and POD3 (P < 0.05).On POD1 and POD3, the levels of IgG, IgA, CD3 lymphocytes, CD4 lymphocytes and the CD4/CD8 ratio in FTS group were significantly higher than those in control group (All P < 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.

ABSTRACT

Background: Our aim was to investigate the influence of FTS on human cellular and humoral immunity using a randomized controlled clinical study in esophageal cancer patients.

Methods: Between October 2013 and December 2014, 276 patients with esophageal cancer in our department were enrolled in the study. The patients were randomized into two groups: FTS pathway group and conventional pathway group. The postoperative hospital stay, hospitalization expenditure, and postoperative complications were recorded. The markers of inflammatory and immune function were measured before operation as well as on the 1st, 3rd, and 7th postoperative days (POD), including serum level of interleukin-6 (IL-6), C-reactive protein (CRP), serum globulin, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA) and lymphocyte subpopulations (CD3 lymphocytes, CD4 lymphocytes, CD8 lymphocytes and the CD4/CD8 ratio) in the patients between the two groups.

Results: In all, 260 patients completed the study: 128 in the FTS group and 132 in the conventional group. We found implementation of FTS pathway decreases postoperative length of stay and hospital charges (P < 0.05). In addition, inflammatory reactions, based on IL-6 and CRP levels, were less intense following FTS pathway compared to conventional pathway on POD1 and POD3 (P < 0.05). On POD1 and POD3, the levels of IgG, IgA, CD3 lymphocytes, CD4 lymphocytes and the CD4/CD8 ratio in FTS group were significantly higher than those in control group (All P < 0.05). However, there were no differences in the level of IgM and CD8 lymphocytes between the two groups.

Conclusions: FTS improves postoperative clinical recovery and effectively inhibited release of inflammatory factors via the immune system after esophagectomy for esophageal cancer.

Trial registration: ChiCTR-TRC-13003562 , the date of registration: August 29, 2013.

No MeSH data available.


Related in: MedlinePlus