Blood Metabolomic Profiling Predicts Postoperative Gastrointestinal Function Of Colorectal Surgical Patients Under The Guidance Of Goal-Directed Fluid Therapy

Abstract

Background: Postoperative gastrointestinal function influences postoperative recovery and hospital stay length for patients undergoing colorectal surgery. Goal-directed fluid therapy (GDFT) restricts fluid administration to an amount required to prevent dehydration. Although the fluid management of GDFT could decrease the incidence of postoperative complications in patients who undergo high-risk surgery, certain patients may not respond to GDFT. Thus, to achieve optimal treatment, identification of patients suitable for GDFT is necessary. Accordingly, in this study, we evaluated the predictive capacity of metabolomics profiling for postoperative recovery after surgery for colorectal cancer.Methods: Metabolomic profiling of 48 patients with colorectal cancer who underwent surgery was performed. Patients were divided into delayed- and enhanced-recovered groups based on gastrointestinal function within 72 hours, and the results of -omics analysis showed differential serum metabolites between the two groups of patients in the postanesthesia care unit 24 hours after surgery. A support vector machine model was applied to evaluate the curative effects of GDFT in different patients.Results: Four metabolites, oleamide, ubiquinone-1, acetylcholine, and oleic acid, were found to be highly associated with postoperative gastrointestinal function and could serve as potential biomarkers. Moreover, four pathways were found to be highly related to postoperative gastrointestinal recovery. Among these, the vitamin B6 metabolism pathway may be a common pathway for improving postoperative recovery in various diseases.Conclusion: Our findings proposed a novel method to predict postoperative recovery of gastrointestinal function based on metabolomic profiling and suggested the potential mechanisms contributing to gastrointestinal function after surgical resection of colorectal cancer under the fluid management of GDFT. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800015899, Registered 27 April 2018, http://www.chictr.org.cn/showproj.aspx?proj=26623