Effect of oral carbohydrate loading on the prognosis of patients undergoing colorectal surgery_West China Medical Journal

Authors：

WANG Wenjian , QIN Peipei ,  MIN Su , JIN Juying , PENG Lihua

Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

MIN Su, Email: ms89011068@163.com

Keywords：

Oral carbohydrate; Colorectal cancer surgery; Enhanced recovery after surgery

DOI：

10.7507/1002-0179.201912220

Video：

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Objectives To explore the effect of preoperative and early postoperative oral carbohydrate on the prognosis of patients undergoing colorectal cancer surgery.Methods A total of 184 patients who underwent laparoscopic colorectal cancer surgery at the First Affiliated Hospital of Chongqing Medical University from March 2019 to July 2019 were selected. They were randomly divided into two groups: the drinking group (n=93) and the non-drinking group (n=91) using a random number table method. The drinking group drank 5 mL/kg carbohydrate clear drink 2 hours before surgery and began to take carbohydrate orally 4 hours after surgery. The non-drinking group was not allowed to drink for 8 hours before surgery and began to drink after exhaustion. The time to first flatus, first defecation in the two groups were observed. The incidence of complications (including aspiration, postoperative intestinal obstruction, anastomotic leakage, incision infection, postoperative nausea and vomiting, and pulmonary infection), postoperative length of stay and total cost of stay in the two groups were observed.Results Compared with the non-drinking group, the time to first flatus (Z=−8.009, P<0.001), the time to first defecation in the drinking group was significantly shorter (Z=−6.263, P<0.001), the incidence of postoperative complications was significantly lower (χ²=12.603, P<0.001), the length of postoperative hospitalization was shorter (t=−5.891, P<0.001). There was no statistical difference in total hospital expenses between the two groups (t=−1.860, P=0.065).Conclusions Oral administration of carbohydrate before and early after colorectal cancer surgery is safe and feasible, which can significantly reduce the overall complications, shorten the length of postoperative hospital stay, and promote the rapid recovery of patients.

Citation： WANG Wenjian, QIN Peipei, MIN Su, JIN Juying, PENG Lihua. Effect of oral carbohydrate loading on the prognosis of patients undergoing colorectal surgery. West China Medical Journal, 2020, 35(8): 958-961. doi: 10.7507/1002-0179.201912220 Copy

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5.	Rizvanović N, Nesek Adam V, Čaušević S, <italic>et al</italic>. A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery. Int J Colorectal Dis, 2019, 34(9): 1551-1561.
6.	Çakar E, Yilmaz E, Çakar E, <italic>et al</italic>. The effect of preoperative oral carbohydrate solution intake on patient comfort: a randomized controlled study. J Perianesth Nurs, 2017, 32(6): 589-599.
7.	Liu B, Wang Y, Liu S, <italic>et al</italic>. A randomized controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing elective craniotomy. Clin Nutr, 2019, 38(5): 2106-2112.
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9.	刘霞, 翟文虎, 陈盼盼, 等. 术前 2 h 饮用碳水化合物对老年胃肠道手术患者胃容量及反流误吸风险的影响: 前瞻性随机对照研究. 协和医学杂志, 2019, 10(6): 589-593.
10.	Stakenborg N, Gomez-Pinilla PJ, Boeckxstaens GE. Postoperative ileus: pathophysiology, current therapeutic approaches. Handb Exp Pharmacol, 2017, 239: 39-57.
11.	Matteoli G, Boeckxstaens GE. The vagal innervation of the gut and immune homeostasis. Gut, 2013, 62(8): 1214-1222.
12.	Lubbers T, Luyer MD, de Haan JJ, <italic>et al</italic>. Lipid-rich enteral nutrition reduces postoperative ileus in rats via activation of cholecystokinin-receptors. Ann Surg, 2009, 249(3): 481-487.
13.	Smeets BJJ, Luyer MDP. Nutritional interventions to improve recovery from postoperative ileus. Curr Opin Clin Nutr Metab Care, 2018, 21(5): 394-398.
14.	Boelens PG, Heesakkers FF, Luyer MD, <italic>et al</italic>. Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial. Ann Surg, 2014, 259(4): 649-655.
15.	Guyton K, Alverdy JC. The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol, 2017, 14(1): 43-54.
16.	刘汉成, 张党政, 王东升, 等. 围手术期不同处理因素对 SD 大鼠肠道菌群的影响. 中华胃肠外科杂志, 2012, 15(6): 581-584.
17.	Peters EG, Dekkers M, van Leeuwen-Hilbers FW, <italic>et al</italic>. Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial. Colorectal Dis, 2017, 19(7): 667-674.
18.	Gao L, Zhao Z, Zhang L, <italic>et al</italic>. Effect of early oral feeding on gastrointestinal function recovery in postoperative gastric cancer patients: a prospective study. J BUON, 2019, 24(1): 194-200.

1. Bray F, Ferlay J, Soerjomataram I, <italic>et al</italic>. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Oliveira KG, Balsan M, Oliveira Sde S, <italic>et al</italic>. Does abbreviation of preoperative fasting to two hours with carbohydrates increase the anesthetic risk?. Rev Bras Anestesiol, 2009, 59(5): 577-584.
3. Osland E, Yunus RM, Khan S, <italic>et al</italic>. Early <italic>versus</italic> traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. JPEN J Parenter Enteral Nutr, 2011, 35(4): 473-487.
4. 张坤, 成思蓉, 朱奇, 等. 结直肠癌患者术后早期与传统经口进食安全性和有效性的 Meta 分析. 中华胃肠外科杂志, 2017, 20(9): 1060-1066.
5. Rizvanović N, Nesek Adam V, Čaušević S, <italic>et al</italic>. A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery. Int J Colorectal Dis, 2019, 34(9): 1551-1561.
6. Çakar E, Yilmaz E, Çakar E, <italic>et al</italic>. The effect of preoperative oral carbohydrate solution intake on patient comfort: a randomized controlled study. J Perianesth Nurs, 2017, 32(6): 589-599.
7. Liu B, Wang Y, Liu S, <italic>et al</italic>. A randomized controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing elective craniotomy. Clin Nutr, 2019, 38(5): 2106-2112.
8. Gava MG, Castro-Barcellos HM, Caporossi C, <italic>et al</italic>. Enhanced muscle strength with carbohydrate supplement two hours before open cholecystectomy: a randomized, double-blind study. Rev Col Bras Cir, 2016, 43(1): 54-59.
9. 刘霞, 翟文虎, 陈盼盼, 等. 术前 2 h 饮用碳水化合物对老年胃肠道手术患者胃容量及反流误吸风险的影响: 前瞻性随机对照研究. 协和医学杂志, 2019, 10(6): 589-593.
10. Stakenborg N, Gomez-Pinilla PJ, Boeckxstaens GE. Postoperative ileus: pathophysiology, current therapeutic approaches. Handb Exp Pharmacol, 2017, 239: 39-57.
11. Matteoli G, Boeckxstaens GE. The vagal innervation of the gut and immune homeostasis. Gut, 2013, 62(8): 1214-1222.
12. Lubbers T, Luyer MD, de Haan JJ, <italic>et al</italic>. Lipid-rich enteral nutrition reduces postoperative ileus in rats via activation of cholecystokinin-receptors. Ann Surg, 2009, 249(3): 481-487.
13. Smeets BJJ, Luyer MDP. Nutritional interventions to improve recovery from postoperative ileus. Curr Opin Clin Nutr Metab Care, 2018, 21(5): 394-398.
14. Boelens PG, Heesakkers FF, Luyer MD, <italic>et al</italic>. Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial. Ann Surg, 2014, 259(4): 649-655.
15. Guyton K, Alverdy JC. The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol, 2017, 14(1): 43-54.
16. 刘汉成, 张党政, 王东升, 等. 围手术期不同处理因素对 SD 大鼠肠道菌群的影响. 中华胃肠外科杂志, 2012, 15(6): 581-584.
17. Peters EG, Dekkers M, van Leeuwen-Hilbers FW, <italic>et al</italic>. Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial. Colorectal Dis, 2017, 19(7): 667-674.
18. Gao L, Zhao Z, Zhang L, <italic>et al</italic>. Effect of early oral feeding on gastrointestinal function recovery in postoperative gastric cancer patients: a prospective study. J BUON, 2019, 24(1): 194-200.

West China Medical Journal

Effect of oral carbohydrate loading on the prognosis of patients undergoing colorectal surgery

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