Clinical Evaluation of Immune-Enhanced Enteral Nutrition in The Elderly Patients after Total Gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Hua , LING Wei , CAO Hui

Department of General Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;

Corresponding author：

Keywords：

Glutamine; Enteral nutrition; Total gastrectomy; Old age; Clinical application

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ObjectiveTo evaluate the effect of glutamineenhanced enteral nutritional support on elder patients after total gastrectomy. MethodsA total of eightyfour cases of elder patients receiving total gastrectomy were included in this study from February 2008 to August 2010. The patients were randomly divided into three groups: glutamineenhanced enteral nutrition (Gln) group, enteral nutrition (EN) group and parenteral nutrition (PN) group. The complications and hospital stay after operation were compared, and the levels of serum total protein, albumin, proalbumin， and transferrin of patients were measured before operation, on 2 d and 10 d after operation, respectively. Furthermore, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio， and the levels of serum IgM and IgG of patients in peripheral blood before and after operation were detected. ResultsNutritional therapy was successfully performed in patients of three groups. The anal exhaust time and hospital stay after operation of patients in Gln group and EN group were significantly lower than those in PN group (P lt;0.05). The difference of postoperative complications and digestive tract symptoms of patients in three groups was not obvious (P lt;0.05). Anastomotic fistula occurred in one patient of PN group on 6 d after operation and was cured by conservative treatment for 54 d. The difference of total protein, albumin, proalbumin, and transferrin levels of patients in three groups before operation was not significant (P gt;0.05), and these indexes fell dramatically on 2 d after operation and lower than before operation (P lt;0.05), although the intergroup difference was not statistically significant (P gt;0.05). On 10 d after operation, all indexes recovered in different extent, while those data in Gln group and EN group were significantly higher than those on 2 d after operation (P lt;0.05). The levels of total protein, albumin, and proalbumin of patients in Gln group and EN group were markedly higher than those in PN group (P lt;0.05), although there was no difference between the former groups (P gt;0.05). The difference of several immunological parameters of patients in three groups before operation was not significant (P gt;0.05). On 10 d after operation, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio, and the levels of serum IgM and IgG of patients in Gln group returned and even exceeded the preoperative results, which were significantly higher than those in EN group and PN group other than IgM (P lt;0.05). The postoperative results of all parameters except IgG in EN group were significantly lower than preoperative results in patients of EN group and PN group (P lt;0.05). ConclusionsIt is safe and feasible to elder patients who had received total gastrectomy and perioperative glutamine-enhanced nutritional support, which can improve nutrition and immune status, promote the recovery and reduce the duration of hospital stay, and nutritiional support after total gastrectomy is one of the optimal choices for these patients.

Citation： LIU Hua,LING Wei,CAO Hui. Clinical Evaluation of Immune-Enhanced Enteral Nutrition in The Elderly Patients after Total Gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(11): 1188-1193. doi: Copy

1.	Dicken BJ, Bigam DL, Cass C, et al. Gastric adenocarcinoma: review and considerations for future directions [J]. Ann Surg, 2005, 241(1): 2739.
2.	樊涛, 宋英杰, 戴冬秋, 等. 胃癌全胃切除术后并发症及死亡率影响因素的logistic分析 [J]. 中国普外基础与临床杂志, 2010, 17(5): 482485.
3.	王德志, 熊茂明, 孟翔凌, 等. 老年胃癌围手术期处理117 例分析 [J]. 中国实用外科杂志, 2009, 29(10): 858859, 865.
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8.	Melis GC, ter Wengel N, Boelens PG, et al. Glutamine: recent developments in research on the clinical significance of glutamine [J]. Curr Opin Clin Nutr Metab Care, 2004, 7(1): 5970.
9.	Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute [J]. J Gastrointest Surg, 2009, 13(2): 239245.
10.	Hyung WJ, Kim SS, Choi WH, et al. Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution [J]. Yonsei Med J, 2008, 49(3): 409415.
11.	张益, 彭志海. 胃癌根治术后早期肠内营养对患者术后恢复情况的影响 [J]. 中国普通外科杂志, 2009, 18(12): 13111313.
12.	Aydin N, Karaz S. Nutritional assessment of patients before gastrointestinal surgery and nurses’ approach to this issue [J]. J Clin Nurs, 2008, 17(5): 608617.
13.	Alici S, Kaya S, Izmirli M, et al. Analysis of survival factors in patient with advancedstage gastric adenocarcinoma [J]. Med Sci Monit, 2006, 12(5): CR221CR229.
14.	Copland L, Liedman B, Rothenberg E, et al. Effects of nutritional support long time after total gastrectomy [J]. Clin Nutr, 2007, 26(5): 605613.
15.	袁琮韦华, 李俊生, 嵇振岭, 等. 全肠外营养及早期肠内营养在胃癌全胃切除术后患者中的对比研究 [J]. 中国普外基础与临床杂志, 2010, 17(4): 357362.
16.	ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients [J]. JPEN J Parenter Enteral Nutr, 2002, 26 (1 Suppl): 1SA138SA.
17.	Wu CW, Chiou JM, Ko FS, et al. Quality of life after curative gastrectomy for gastric cancer in a randomised controlled trial [J]. Br J Cancer, 2008, 98(1): 5459.
18.	郑超球, 王成忠, 郭宇. 早期肠内营养在预防胃大部切除术后残胃排空障碍中的作用 [J]. 肠外与肠内营养, 2010, 17(3): 150152.
19.	Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systemic review and metaanalysis of randomized controlled trials in the English literatures [J]. J Gastrointest Surg, 2008, 12(4): 739755.
20.	魏玉哲, 宋洪江, 王佳, 等. ω3多不饱和脂肪酸在老年胃癌病人术后肠外营养中的应用 [J]. 肠外与肠内营养, 2009, 16(6): 328331.
21.	刘流, 庄文, 陈忠. ω3不饱和脂肪酸促进胃肠道恶性肿瘤患者术后康复的疗效研究 [J]. 中国普外基础与临床杂志, 2009, 16(11): 895899.
22.	黄昌明, 张祥福, 卢辉山, 等. 全胃切除术治疗胃底贲门癌的远期疗效 [J]. 中华外科杂志, 2003, 41(10): 729732.
23.	Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients [J]. World J Gastroenterol, 2010, 16(26): 33103317.
24.	Barbieri C, Fujisawa MM, Yasuda CL, et al. Effect of surgical treatment on the cellular immune response of gastric cancer patients [J]. Braz J Biol Res, 2003, 36(3): 339345.
25.	MoghimiDehkordi B, Safaee A, Zali MR. Survival rates and prognosis of gastric cancer using an actuarial lifetable method [J]. Asia Pac J Cancer Prev, 2008, 9(2): 317321.
26.	Ishikawa M, Nishioka M, Hanaki N, et al. Perioperative immune responses in cancer patients undergoing digestive surgeries [J]. World J Surg Oncol, 2009， 7: 7.
27.	Ishikawa M, Nishioka M, Hanaki N, et al. Hepatic resection leads to a shift in the Th 1/2 balance toward Th 2 and produces hypermetabolic and hyperhemodynamic states [J]. Hepatogastroenterology, 2004, 51(59): 14221427.
28.	Ishikawa M, Nishioka M, Hanaki N, et al. Postoperative host responses in elderly patients after gastrointestinal surgery [J]. Hepatogastroenterology, 2006, 53(71): 730735.

1. Dicken BJ, Bigam DL, Cass C, et al. Gastric adenocarcinoma: review and considerations for future directions [J]. Ann Surg, 2005, 241(1): 2739.
2. 樊涛, 宋英杰, 戴冬秋, 等. 胃癌全胃切除术后并发症及死亡率影响因素的logistic分析 [J]. 中国普外基础与临床杂志, 2010, 17(5): 482485.
3. 王德志, 熊茂明, 孟翔凌, 等. 老年胃癌围手术期处理117 例分析 [J]. 中国实用外科杂志, 2009, 29(10): 858859, 865.
4. 阚永丰, 郑毅, 李世拥, 等. 1 142例胃癌切除术围手术期死亡因素分析 [J]. 中华胃肠外科杂志, 2005, 8(5): 422424.
5. 李江, 刘斌, 侯宇, 等. 腹部外科术后早期肠内营养的临床研究与应用 [J]. 中国普外基础与临床杂志, 2006, 13(3): 355357.
6. Dannull J, Su Z, Rizzieri D, et al. Enhancement of vaccinemediated antitumor immunity in cancer patients after depletion of regulatory T cells [J]. J Clin Invest, 2005, 115(12): 36233633.
7. Sah BK, Zhu ZG, Wang XY, et al. Postoperative complications of gastric cancer surgery: female gender at high risk [J]. Eur J Cancer Care (Engl), 2009, 18(2): 202208.
8. Melis GC, ter Wengel N, Boelens PG, et al. Glutamine: recent developments in research on the clinical significance of glutamine [J]. Curr Opin Clin Nutr Metab Care, 2004, 7(1): 5970.
9. Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute [J]. J Gastrointest Surg, 2009, 13(2): 239245.
10. Hyung WJ, Kim SS, Choi WH, et al. Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution [J]. Yonsei Med J, 2008, 49(3): 409415.
11. 张益, 彭志海. 胃癌根治术后早期肠内营养对患者术后恢复情况的影响 [J]. 中国普通外科杂志, 2009, 18(12): 13111313.
12. Aydin N, Karaz S. Nutritional assessment of patients before gastrointestinal surgery and nurses’ approach to this issue [J]. J Clin Nurs, 2008, 17(5): 608617.
13. Alici S, Kaya S, Izmirli M, et al. Analysis of survival factors in patient with advancedstage gastric adenocarcinoma [J]. Med Sci Monit, 2006, 12(5): CR221CR229.
14. Copland L, Liedman B, Rothenberg E, et al. Effects of nutritional support long time after total gastrectomy [J]. Clin Nutr, 2007, 26(5): 605613.
15. 袁琮韦华, 李俊生, 嵇振岭, 等. 全肠外营养及早期肠内营养在胃癌全胃切除术后患者中的对比研究 [J]. 中国普外基础与临床杂志, 2010, 17(4): 357362.
16. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients [J]. JPEN J Parenter Enteral Nutr, 2002, 26 (1 Suppl): 1SA138SA.
17. Wu CW, Chiou JM, Ko FS, et al. Quality of life after curative gastrectomy for gastric cancer in a randomised controlled trial [J]. Br J Cancer, 2008, 98(1): 5459.
18. 郑超球, 王成忠, 郭宇. 早期肠内营养在预防胃大部切除术后残胃排空障碍中的作用 [J]. 肠外与肠内营养, 2010, 17(3): 150152.
19. Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systemic review and metaanalysis of randomized controlled trials in the English literatures [J]. J Gastrointest Surg, 2008, 12(4): 739755.
20. 魏玉哲, 宋洪江, 王佳, 等. ω3多不饱和脂肪酸在老年胃癌病人术后肠外营养中的应用 [J]. 肠外与肠内营养, 2009, 16(6): 328331.
21. 刘流, 庄文, 陈忠. ω3不饱和脂肪酸促进胃肠道恶性肿瘤患者术后康复的疗效研究 [J]. 中国普外基础与临床杂志, 2009, 16(11): 895899.
22. 黄昌明, 张祥福, 卢辉山, 等. 全胃切除术治疗胃底贲门癌的远期疗效 [J]. 中华外科杂志, 2003, 41(10): 729732.
23. Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients [J]. World J Gastroenterol, 2010, 16(26): 33103317.
24. Barbieri C, Fujisawa MM, Yasuda CL, et al. Effect of surgical treatment on the cellular immune response of gastric cancer patients [J]. Braz J Biol Res, 2003, 36(3): 339345.
25. MoghimiDehkordi B, Safaee A, Zali MR. Survival rates and prognosis of gastric cancer using an actuarial lifetable method [J]. Asia Pac J Cancer Prev, 2008, 9(2): 317321.
26. Ishikawa M, Nishioka M, Hanaki N, et al. Perioperative immune responses in cancer patients undergoing digestive surgeries [J]. World J Surg Oncol, 2009， 7: 7.
27. Ishikawa M, Nishioka M, Hanaki N, et al. Hepatic resection leads to a shift in the Th 1/2 balance toward Th 2 and produces hypermetabolic and hyperhemodynamic states [J]. Hepatogastroenterology, 2004, 51(59): 14221427.
28. Ishikawa M, Nishioka M, Hanaki N, et al. Postoperative host responses in elderly patients after gastrointestinal surgery [J]. Hepatogastroenterology, 2006, 53(71): 730735.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Evaluation of Immune-Enhanced Enteral Nutrition in The Elderly Patients after Total Gastrectomy

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