Clinical Effects of Postoperative Restrict Rehydration on Different Body Mass Index of Patients with Colorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIAO Ling ^1,2,3 , WANG Haoyang ^1,2,4 , YU Xi ^1,2,4 , WANG Xiaodong ^1,2 , LI Li ^1,2

1.Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China Hospital MCQ Team, Sichuan University, Chengdu 610041, China;;
3.West China College of Stomatology, Sichuan University, Chengdu 610041, China;;
4.West China Medical School, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Fasttrack; Colorectal cancer; Body mass index; Restrict rehydration

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Objective To explore the clinical effects of postoperative restrict rehydration on different body mass index (BMI) of patients with colorectal cancer.
Methods From January 2008 to January 2009, the patients diagnosed definitely as colorectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different BMI (underweight group, normal group, overweight group).
Results The first defecation time, aerofluxus time and ambulation time of the fluid restriction group were significantly earlier than those of the tradition therapy group (P lt;0.05), and postoperative in-hospital time was also less (P lt;0.05). However, the differences of early postoperative rehabilitation among underweight group, normal group and overweight group in the tradition therapy group and fluid restriction group had no statistical significance (P gt;0.05). The complications such as pulmonary infection, anastomotic leakage, intestinal obstruction and wound dehiscence in the fluid restriction group were significantly lower than those in the tradition therapy group (P lt;0.05). In the tradition therapy group, the incidences of anastomotic leakage and wound dehiscence in overweight group were significantly higher than those in the underweight and normal group (P lt;0.05). The rate of postoperative complications among underweight group, normal group and overweight group in the fluid restriction group had no statistical significance (P gt;0.05).
Conclusion Postoperative restrict rehydration for overweight colorectal cancer patients has a good clinical effect, which can promote the early postoperative rehabilitation.

Citation： XIAO Ling ,WANG Haoyang,YU Xi,WANG Xiaodong,LI Li. Clinical Effects of Postoperative Restrict Rehydration on Different Body Mass Index of Patients with Colorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(3): 289-293. doi: Copy

1.	Schwenk W, Haase O, Raue W, et al. Establishing “fast track” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129(6): 502509.
2.	刘展, 汪晓东, 李立. 多学科协作诊治模式下的结直肠外科快速康复流程 [J].中国普外基础与临床杂志, 2007; 14(2): 239242.
3.	Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 18121818.
4.	Brandstrup B, Tnnesen H, BeierHolgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg, 2003; 238(5): 641648.
5.	肖凌, 黄真真, 李蔚, 等. 快速流程模式中术后限制补液在老年结直肠癌患者中的应用价值 [J]. 中国普外基础与临床杂志, 2010; 17(1): 8791.
6.	肖凌，李蔚，麦玲，等. 快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响 [J]. 中国普外基础与临床杂志, 2010; 17(2): 190194.
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8.	Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
9.	World Health Organization, media centre. overweight and obese. BMI classification. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed March 30, 2008.
10.	吕东昊, 汪晓东, 阳川华, 等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志, 2007; 14(6): 713716.
11.	Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355360.
12.	Calle EE, Rodriguez C, WalkerThurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults [J]. N Engl J Med, 2003; 348(17): 16251638.
13.	Merkow RP, Bilimoria KY, McCarter MD, et al. Effect of body mass index on shortterm outcomes after colectomy for cancer [J]. J Am Coll Surg, 2009; 208(1): 5361.
14.	Sadr Azodi O, Lindstrm D, Adami J, et al. Impact of body mass index and tobacco smoking on outcome after open appendicectomy [J]. Br J Surg, 2008; 95(6): 751757.
15.	Gendall KA, Raniga S, Kennedy R, et al. The impact of obesity on outcome after major colorectal surgery [J]. Dis Colon Rectum, 2007; 50(12): 22232237.
16.	肖凌, 汪晓东, 李立. 术后液体管理在结直肠外科快速流程中的应用进展 [J]. 中国普外基础与临床杂志, 2009; 17(7): 593596.
17.	Norman K, Kirchner H, Lochs H, et al. Malnutrition affects quality of life in gastroenterology patients [J]. World J Gastroenterol, 2006; 12(21): 33803385.
18.	Hannemann P, Lassen K, Hausel J, et al. Patterns in current anaesthesiological perioperative practice for colonic resections: a survey in five northernEuropean countries [J]. Acta Anaesthesiol Scand, 2006; 50(9): 11521160.
19.	Soeters PB, de Zoete JP, Dejong CH, et al. Colorectal surgery and anastomotic leakage [J]. Dig Surg, 2002; 19(2): 150155.
20.	Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
21.	Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
22.	Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg, 2006; 93(9): 10691076.
23.	Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
24.	HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med,1997; 23(3): 276281.
25.	Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.
26.	Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
27.	von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
28.	Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
29.	Dindo D, Muller MK, Weber M, et al. Obesity in general elective surgery [J]. Lancet, 2003; 361(9374): 20322035.
30.	Benoist S, Panis Y, Alves A, et al. Impact of obesity on surgical outcomes after colorectal resection [J]. Am J Surg, 2000; 179(4): 275281.
31.	Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection [J]. Ann Surg, 2004; 239(5): 599605.
32.	Chappell D, Jacob M, HofmannKiefer K, et al. A rational approach to perioperative fluid management [J]. Anesthesiology, 2008; 109(4): 723740.

1. Schwenk W, Haase O, Raue W, et al. Establishing “fast track” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129(6): 502509.
2. 刘展, 汪晓东, 李立. 多学科协作诊治模式下的结直肠外科快速康复流程 [J].中国普外基础与临床杂志, 2007; 14(2): 239242.
3. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 18121818.
4. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg, 2003; 238(5): 641648.
5. 肖凌, 黄真真, 李蔚, 等. 快速流程模式中术后限制补液在老年结直肠癌患者中的应用价值 [J]. 中国普外基础与临床杂志, 2010; 17(1): 8791.
6. 肖凌，李蔚，麦玲，等. 快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响 [J]. 中国普外基础与临床杂志, 2010; 17(2): 190194.
7. 吴在德, 吴肇汉. 外科学 [M]. 第7版. 北京: 人民卫生出版社, 2008: 66.
8. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
9. World Health Organization, media centre. overweight and obese. BMI classification. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed March 30, 2008.
10. 吕东昊, 汪晓东, 阳川华, 等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志, 2007; 14(6): 713716.
11. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355360.
12. Calle EE, Rodriguez C, WalkerThurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults [J]. N Engl J Med, 2003; 348(17): 16251638.
13. Merkow RP, Bilimoria KY, McCarter MD, et al. Effect of body mass index on shortterm outcomes after colectomy for cancer [J]. J Am Coll Surg, 2009; 208(1): 5361.
14. Sadr Azodi O, Lindstrm D, Adami J, et al. Impact of body mass index and tobacco smoking on outcome after open appendicectomy [J]. Br J Surg, 2008; 95(6): 751757.
15. Gendall KA, Raniga S, Kennedy R, et al. The impact of obesity on outcome after major colorectal surgery [J]. Dis Colon Rectum, 2007; 50(12): 22232237.
16. 肖凌, 汪晓东, 李立. 术后液体管理在结直肠外科快速流程中的应用进展 [J]. 中国普外基础与临床杂志, 2009; 17(7): 593596.
17. Norman K, Kirchner H, Lochs H, et al. Malnutrition affects quality of life in gastroenterology patients [J]. World J Gastroenterol, 2006; 12(21): 33803385.
18. Hannemann P, Lassen K, Hausel J, et al. Patterns in current anaesthesiological perioperative practice for colonic resections: a survey in five northernEuropean countries [J]. Acta Anaesthesiol Scand, 2006; 50(9): 11521160.
19. Soeters PB, de Zoete JP, Dejong CH, et al. Colorectal surgery and anastomotic leakage [J]. Dig Surg, 2002; 19(2): 150155.
20. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
21. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
22. Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg, 2006; 93(9): 10691076.
23. Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
24. HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med,1997; 23(3): 276281.
25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.
26. Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
27. von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
28. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
29. Dindo D, Muller MK, Weber M, et al. Obesity in general elective surgery [J]. Lancet, 2003; 361(9374): 20322035.
30. Benoist S, Panis Y, Alves A, et al. Impact of obesity on surgical outcomes after colorectal resection [J]. Am J Surg, 2000; 179(4): 275281.
31. Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection [J]. Ann Surg, 2004; 239(5): 599605.
32. Chappell D, Jacob M, HofmannKiefer K, et al. A rational approach to perioperative fluid management [J]. Anesthesiology, 2008; 109(4): 723740.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Effects of Postoperative Restrict Rehydration on Different Body Mass Index of Patients with Colorectal Cancer

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