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Fast-Track Improves Post-Operative Nutrition and Outcomes of Colorectal Surgery: A Single-Center Prospective Trial in China

加速康复外科改善结直肠癌患者术后营养状态及临床效果:中国的一项单中心、前瞻性研究

摘要


Fast-track (FT) has been shown to enhance post-operative recovery. The aim of this study was to compare the effects of FT and traditional nutrition on post-operative rehabilitation, as well as evaluate the feasibility of applying FT in nutrition management of colorectal surgery. A prospective and randomized controlled trial was performed. This study included 464 patients who underwent colorectal surgery. The patients were randomly assigned into an FT group and a traditional group. The nutritional risk screening (NRS 2002) score, post-operative recovery index and surgical complications were compared between the FT and traditional groups. The NRS 2002 score in the FT group was better than the traditional group (p<0.05). Serum indicators for nutrition (HGB, ALB, A/G) and immune function (lymphocyte rate [LYMPH%], IgA, and CD4+) in the FT group were superior to those in the traditional group (p<0.05) on post-operative day 5. The first time to aerofluxus, defecation, oral intake and ambulation in the FT group was shorter when compared to the traditional group (p<0.05). The complication incidence was significantly lower in the FT group than in the traditional group (p<0.05). In particular, the occurrence rate of anastomotic leakage was higher in the traditional group than in the FT group (0.5% vs 2.8%, p<0.05). Taken together, these data suggest that FT management can improve the nutritional condition and outcomes of colorectal surgical patients.

並列摘要


Fast-track (FT) has been shown to enhance post-operative recovery. The aim of this study was to compare the effects of FT and traditional nutrition on post-operative rehabilitation, as well as evaluate the feasibility of applying FT in nutrition management of colorectal surgery. A prospective and randomized controlled trial was performed. This study included 464 patients who underwent colorectal surgery. The patients were randomly assigned into an FT group and a traditional group. The nutritional risk screening (NRS 2002) score, post-operative recovery index and surgical complications were compared between the FT and traditional groups. The NRS 2002 score in the FT group was better than the traditional group (p<0.05). Serum indicators for nutrition (HGB, ALB, A/G) and immune function (lymphocyte rate [LYMPH%], IgA, and CD4+) in the FT group were superior to those in the traditional group (p<0.05) on post-operative day 5. The first time to aerofluxus, defecation, oral intake and ambulation in the FT group was shorter when compared to the traditional group (p<0.05). The complication incidence was significantly lower in the FT group than in the traditional group (p<0.05). In particular, the occurrence rate of anastomotic leakage was higher in the traditional group than in the FT group (0.5% vs 2.8%, p<0.05). Taken together, these data suggest that FT management can improve the nutritional condition and outcomes of colorectal surgical patients.

並列關鍵字

fast-track nutrition post-operative colorectal prospective

參考文獻


Lovely JK, Maxson PM, Jacob AK, Cima RR, Horlocker TT, Hebl JR, Harmsen WS, Huebner M, Larson DW. Casematched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery. Br J Surg. 2012;99:120-6. doi: 10.1002/bjs.7692
Ramírez JM, Blasco JA, Roig JV, Maeso-Martínez S, Casal JE, Esteban F, Lic DC; Spanish working group on fast track surgery. Enhanced recovery in colorectal surgery: a multicentre study. BMC Surg. 2011;11:9. doi: 10.1186/1471-24 82-11-9
Barret M, Malka D, Aparicio T, Dalban C, Locher C, Sabate JM, et al. Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter study. Oncology. 2011;81: 395-402. doi: 10.1159/000335478
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003;22:415- 21. doi: 10.1016/S0261-5614(03)00098-0
Can MF, Yagci G, Dag B, Ozturk E, Gorgulu S, Simsek A, Tufan T. Preoperative administration of oral carbohydraterich solutions: Comparison of glucometabolic responses and tolerability between patients with and without insulin resistance. Nutrition. 2009;25:72-7. doi: 10.1016/ j.nut.2008. 07.021

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