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.	鲍淑梅, 张亚杰, 田丰. 炎症性肠病合并结直肠癌的流行病学和防治进展. 中国临床医生杂志, 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.	姜卫生, 张振豪, 汪长青, 等. 减孔腹腔镜手术治疗对结直肠癌患者免疫功能、氧化应激反应的影响. 中国临床医生杂志, 2022, 50(4): 450-452.
6.	崔宇, 沈贵虎, 王浩. 腹腔镜结直肠癌根治术对结直肠癌患者氧化应激及能量代谢的影响. 贵州医药, 2020, 44(10): 1546-1547.
7.	中华人民共和国国家卫生和计划生育委员会医政医管局, 中华医学会肿瘤学分会. 结直肠癌诊疗规范(2015年版). 肿瘤综合治疗电子杂志, 2017, 3(1): 6-24.
8.	高明, 周华, 朱研, 等. 间接测热法与预测公式对肝脏术后患者能量消耗评估的差异性分析. 临床急诊杂志, 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, 陈雷, 陈焰, 等. 腹腔镜下保留左结肠血管手术治疗中低位直肠癌效果及安全性. 临床军医杂志, 2021, 49(12): 1383-1388.
15.	周志涛, 郭磊, 王峰. 腹腔镜直肠全系膜切除术对低位直肠癌患者氧化应激、能量代谢及预后的影响. 中国医学前沿杂志(电子版), 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.	杨阳, 宋红霞, 陶连元, 等. 急性胰腺炎患者间接测热法和公式预估法计算每日总能量消耗的比较. 中华肝胆外科杂志, 2021, 27(9): 676-680.
19.	黄宝玉, 田景中, 李光云, 等. 腹腔镜与开腹式结直肠癌根治术对细胞免疫和氧化应激及能量代谢的影响. 中国医药, 2021, 16(9): 1365-1368.
20.	何利, 何茂梁, 袁波, 等. 腹腔镜手术治疗对结直肠癌患者血清炎性因子、VEGF、MMP-9、氧化应激及免疫功能的影响. 海南医学院学报, 2017, 23(18): 2546-2549.

1. 鲍淑梅, 张亚杰, 田丰. 炎症性肠病合并结直肠癌的流行病学和防治进展. 中国临床医生杂志, 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. 姜卫生, 张振豪, 汪长青, 等. 减孔腹腔镜手术治疗对结直肠癌患者免疫功能、氧化应激反应的影响. 中国临床医生杂志, 2022, 50(4): 450-452.
6. 崔宇, 沈贵虎, 王浩. 腹腔镜结直肠癌根治术对结直肠癌患者氧化应激及能量代谢的影响. 贵州医药, 2020, 44(10): 1546-1547.
7. 中华人民共和国国家卫生和计划生育委员会医政医管局, 中华医学会肿瘤学分会. 结直肠癌诊疗规范(2015年版). 肿瘤综合治疗电子杂志, 2017, 3(1): 6-24.
8. 高明, 周华, 朱研, 等. 间接测热法与预测公式对肝脏术后患者能量消耗评估的差异性分析. 临床急诊杂志, 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, 陈雷, 陈焰, 等. 腹腔镜下保留左结肠血管手术治疗中低位直肠癌效果及安全性. 临床军医杂志, 2021, 49(12): 1383-1388.
15. 周志涛, 郭磊, 王峰. 腹腔镜直肠全系膜切除术对低位直肠癌患者氧化应激、能量代谢及预后的影响. 中国医学前沿杂志(电子版), 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. 杨阳, 宋红霞, 陶连元, 等. 急性胰腺炎患者间接测热法和公式预估法计算每日总能量消耗的比较. 中华肝胆外科杂志, 2021, 27(9): 676-680.
19. 黄宝玉, 田景中, 李光云, 等. 腹腔镜与开腹式结直肠癌根治术对细胞免疫和氧化应激及能量代谢的影响. 中国医药, 2021, 16(9): 1365-1368.
20. 何利, 何茂梁, 袁波, 等. 腹腔镜手术治疗对结直肠癌患者血清炎性因子、VEGF、MMP-9、氧化应激及免疫功能的影响. 海南医学院学报, 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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