Influence of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHONG Jie , HE Yuhua , JIANG Lili ,  YANG Jie

Colorectal Cancer Center, West China Hospital, Sichuan University/West China Nursing College of Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

YANG Jie, Email: 18980606084@126.com

Keywords：

indirect calorimetry; nutritional support; laparoscopic surgery; colorectal cancer; energy metabolism

DOI：

10.7507/1007-9424.202208035

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Objective To study the effect of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery. Methods A total of 96 patients with colorectal cancer after laparoscopic surgery in our hospital from December 2019 to December 2021 were selected and randomly divided into the control group (used the formula prediction method to guide enteral nutrition support, n=48) and the observation group (used indirect calorimetry to guide enteral nutrition support, n=48). The target resting energy expenditure (REE) value and nutritional support energy intake were compared between the two groups. The cellular immune indexes (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺) and oxidative stress indexes [serum superoxide dismutase (SOD), malondialdehyde (MDA), the changes of glutathione peroxidase (GSH-Px)], and the changes of REE at different time points (1 day before operation and 1, 2 and 3 days after operation) of the two groups were compared. The incidence of complications in the two groups were observed. Results The target REE value of the observation group was lower than that of the control group (P＜0.05), and there was no significant difference in the enteral energy intake and parenteral energy intake compared with the control group (P＞0.05). After treatment, CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the two groups were lower than those before treatment (P<0.05), and CD8⁺ was higher than before treatment (P<0.05). The levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the observation group after treatment were higher than those in the control group (P<0.05) , while the level of CD8⁺ in the observation group was lower than that in the control group (P<0.05). After treatment, the levels of SOD and GSH-Px in the two groups were lower than those before treatment (P<0.05), and the levels of MDA were higher than those before treatment (P<0.05). The levels of GSH-Px and SOD in the observation group were higher than those in the control group (P<0.05), while the level of MDA in the observation group was lower than that in the control group (P<0.05). There was no significant difference in the REE value between the two groups at 1 day before operation (P>0.05); compared with the 1 day before operation, the REE values of the two groups at 1, 2, and 3 days after operation were significantly increased, and there was a statistically significant difference between the two groups at each time point (P<0.05), but the REE value at 3 days after operation was significantly lower than that at 1 and 2 days after operation (P<0.05). The REE values in the observation group were lower than those in the control group at 1, 2 and 3 days after operation (P<0.05). The incidence of complications in the observation group was 6.25%, which was lower than 20.83% in the control group (P<0.05). Conclusion Enteral nutrition support guided by indirect calorimetry in colorectal cancer patients after laparoscopic surgery can help reduce postoperative energy consumption, improve cellular immune function and oxidative stress response, and reduce the risk of postoperative complications, which is worthy of promotion.

Citation： ZHONG Jie, HE Yuhua, JIANG Lili, YANG Jie. Influence of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 192-197. doi: 10.7507/1007-9424.202208035 Copy

1.	鮑淑梅, 張亞杰, 田豐. 炎癥性腸病合并結直腸癌的流行病學和防治進展. 中國臨床醫生雜志, 2021, 49(12): 1409-1413.
2.	Pantalos G, Patsouras D, Spartalis E, et al. Three-dimensional versus two-dimensional laparoscopic surgery for colorectal cancer: systematic review and meta-analysis. In Vivo, 2020, 34(1): 11-21.
3.	Kojima Y, Sakamoto K, Okuzawa A. Experience of using a spray-type anti-adhesion barrier in laparoscopic surgery for colorectal cancer. J Surg Case Rep, 2019, 2019(3): rjz085. doi: 10.1093/jscr/rjz085.
4.	Tsuruta M, Hasegawa H, Okabayashi Koji, et al. Needlescopic versus conventional laparoscopic surgery for colorectal cancer: a comparative study. J Anus Rectum Colon, 201, 1(2): 45-49.
5.	姜衛生, 張振豪, 汪長青, 等. 減孔腹腔鏡手術治療對結直腸癌患者免疫功能、氧化應激反應的影響. 中國臨床醫生雜志, 2022, 50(4): 450-452.
6.	崔宇, 沈貴虎, 王浩. 腹腔鏡結直腸癌根治術對結直腸癌患者氧化應激及能量代謝的影響. 貴州醫藥, 2020, 44(10): 1546-1547.
7.	中華人民共和國國家衛生和計劃生育委員會醫政醫管局, 中華醫學會腫瘤學分會. 結直腸癌診療規范(2015年版). 腫瘤綜合治療電子雜志, 2017, 3(1): 6-24.
8.	高明, 周華, 朱研, 等. 間接測熱法與預測公式對肝臟術后患者能量消耗評估的差異性分析. 臨床急診雜志, 2021, 22(1): 42-45.
9.	Zanella PB, Avila CC, Souza C. Estimating resting energy expenditure by different methods as compared with indirect calorimetry for patients with pulmonary hypertension. Nutr Clin Pract, 2018, 33(2): 217-223.
10.	Fukuoka E, Matsuda T, Hasegawa H, et al. Laparoscopic vs open surgery for colorectal cancer patients with high American Society of Anesthesiologists classes. Asian J Endosc Surg, 2020, 13(3): 336-342.
11.	Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. John Wiley & Sons, Hoboken, NJ, USA: 2017: 8-9.
12.	Wada Y, Miyoshi N, Fujino S, et al. New marking method involving a light-emitting diode and power source device to localize gastrointestinal cancer in laparoscopic surgery. Sci Rep, 2019, 9(1): 5485. doi: 10.1038/s41598-019-41981-w.
13.	Duque P, Garutti I, Terradillos E, et al. Modulation of CCL2 expression by laparoscopic versus open surgery for colorectal cancer surgery. Surg Laparosc Endosc Percutan Tech, 2019, 29(2): 101-108.
14.	孔令永, 陳雷, 陳焰, 等. 腹腔鏡下保留左結腸血管手術治療中低位直腸癌效果及安全性. 臨床軍醫雜志, 2021, 49(12): 1383-1388.
15.	周志濤, 郭磊, 王峰. 腹腔鏡直腸全系膜切除術對低位直腸癌患者氧化應激、能量代謝及預后的影響. 中國醫學前沿雜志(電子版), 2020, 12(9): 129-133.
16.	Siddiqui J, Young CJ. Thirteen-year experience with hand-assisted laparoscopic surgery in colorectal patients. ANZ J Surg, 2020, 90(2): 113-118.
17.	Mascherini G, Ringressi MN, Castizo-Olier J, et al. Preliminary results of an exercise program after laparoscopic resective colorectal cancer surgery in non-metastatic adenocarcinoma: a pilot study of a randomized control trial. Medicina (Kaunas), 2020, 56(2): 78. doi: 10.3390/medicina56020078.
18.	楊陽, 宋紅霞, 陶連元, 等. 急性胰腺炎患者間接測熱法和公式預估法計算每日總能量消耗的比較. 中華肝膽外科雜志, 2021, 27(9): 676-680.
19.	黃寶玉, 田景中, 李光云, 等. 腹腔鏡與開腹式結直腸癌根治術對細胞免疫和氧化應激及能量代謝的影響. 中國醫藥, 2021, 16(9): 1365-1368.
20.	何利, 何茂梁, 袁波, 等. 腹腔鏡手術治療對結直腸癌患者血清炎性因子、VEGF、MMP-9、氧化應激及免疫功能的影響. 海南醫學院學報, 2017, 23(18): 2546-2549.

1. 鮑淑梅, 張亞杰, 田豐. 炎癥性腸病合并結直腸癌的流行病學和防治進展. 中國臨床醫生雜志, 2021, 49(12): 1409-1413.
2. Pantalos G, Patsouras D, Spartalis E, et al. Three-dimensional versus two-dimensional laparoscopic surgery for colorectal cancer: systematic review and meta-analysis. In Vivo, 2020, 34(1): 11-21.
3. Kojima Y, Sakamoto K, Okuzawa A. Experience of using a spray-type anti-adhesion barrier in laparoscopic surgery for colorectal cancer. J Surg Case Rep, 2019, 2019(3): rjz085. doi: 10.1093/jscr/rjz085.
4. Tsuruta M, Hasegawa H, Okabayashi Koji, et al. Needlescopic versus conventional laparoscopic surgery for colorectal cancer: a comparative study. J Anus Rectum Colon, 201, 1(2): 45-49.
5. 姜衛生, 張振豪, 汪長青, 等. 減孔腹腔鏡手術治療對結直腸癌患者免疫功能、氧化應激反應的影響. 中國臨床醫生雜志, 2022, 50(4): 450-452.
6. 崔宇, 沈貴虎, 王浩. 腹腔鏡結直腸癌根治術對結直腸癌患者氧化應激及能量代謝的影響. 貴州醫藥, 2020, 44(10): 1546-1547.
7. 中華人民共和國國家衛生和計劃生育委員會醫政醫管局, 中華醫學會腫瘤學分會. 結直腸癌診療規范(2015年版). 腫瘤綜合治療電子雜志, 2017, 3(1): 6-24.
8. 高明, 周華, 朱研, 等. 間接測熱法與預測公式對肝臟術后患者能量消耗評估的差異性分析. 臨床急診雜志, 2021, 22(1): 42-45.
9. Zanella PB, Avila CC, Souza C. Estimating resting energy expenditure by different methods as compared with indirect calorimetry for patients with pulmonary hypertension. Nutr Clin Pract, 2018, 33(2): 217-223.
10. Fukuoka E, Matsuda T, Hasegawa H, et al. Laparoscopic vs open surgery for colorectal cancer patients with high American Society of Anesthesiologists classes. Asian J Endosc Surg, 2020, 13(3): 336-342.
11. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. John Wiley & Sons, Hoboken, NJ, USA: 2017: 8-9.
12. Wada Y, Miyoshi N, Fujino S, et al. New marking method involving a light-emitting diode and power source device to localize gastrointestinal cancer in laparoscopic surgery. Sci Rep, 2019, 9(1): 5485. doi: 10.1038/s41598-019-41981-w.
13. Duque P, Garutti I, Terradillos E, et al. Modulation of CCL2 expression by laparoscopic versus open surgery for colorectal cancer surgery. Surg Laparosc Endosc Percutan Tech, 2019, 29(2): 101-108.
14. 孔令永, 陳雷, 陳焰, 等. 腹腔鏡下保留左結腸血管手術治療中低位直腸癌效果及安全性. 臨床軍醫雜志, 2021, 49(12): 1383-1388.
15. 周志濤, 郭磊, 王峰. 腹腔鏡直腸全系膜切除術對低位直腸癌患者氧化應激、能量代謝及預后的影響. 中國醫學前沿雜志(電子版), 2020, 12(9): 129-133.
16. Siddiqui J, Young CJ. Thirteen-year experience with hand-assisted laparoscopic surgery in colorectal patients. ANZ J Surg, 2020, 90(2): 113-118.
17. Mascherini G, Ringressi MN, Castizo-Olier J, et al. Preliminary results of an exercise program after laparoscopic resective colorectal cancer surgery in non-metastatic adenocarcinoma: a pilot study of a randomized control trial. Medicina (Kaunas), 2020, 56(2): 78. doi: 10.3390/medicina56020078.
18. 楊陽, 宋紅霞, 陶連元, 等. 急性胰腺炎患者間接測熱法和公式預估法計算每日總能量消耗的比較. 中華肝膽外科雜志, 2021, 27(9): 676-680.
19. 黃寶玉, 田景中, 李光云, 等. 腹腔鏡與開腹式結直腸癌根治術對細胞免疫和氧化應激及能量代謝的影響. 中國醫藥, 2021, 16(9): 1365-1368.
20. 何利, 何茂梁, 袁波, 等. 腹腔鏡手術治療對結直腸癌患者血清炎性因子、VEGF、MMP-9、氧化應激及免疫功能的影響. 海南醫學院學報, 2017, 23(18): 2546-2549.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Influence of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery

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