Effect of single-incision laparoscopic distal gastrectomy guided by ERAS and the influence on immune function

Jun, Zhou; Lin, Sheng; Sun, Si-Da; Zheng, Chengying; Wang, Jiaxing; He, Qingliang

doi:10.1186/s12957-021-02422-z

Cited by 7 publications

(5 citation statements)

References 31 publications

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“…revealed that the serum immunoglobulin levels of piglets supplemented with C. butyricum and Enterococcus faecalis increased sharply in IgA, IgG and IgM levels ( 30 ). CD3 + T cell is the main reference index of immune function, and can be used as the total cellular immune state of the body ( 31 ). This study indicated that the index changes of CD3 + T cell, CD4 + T cell and CD4 + /CD8 + ratio in patients taking C. butyricum orally after gastrectomy were better than those without administration.…”

Section: Discussionmentioning

confidence: 99%

Clostridium butyricum potentially improves inflammation and immunity through alteration of the microbiota and metabolism of gastric cancer patients after gastrectomy

Cao

Zheng

et al. 2022

Front. Immunol.

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BackgroundGastrectomy is the most effective treatment to improve the clinical survival rate of patients with gastric cancer. However, the pathophysiological changes caused by gastrectomy have seriously affected the postoperative recovery.MethodsIn the present trial, Ataining (containing C. butyricum, CGMCC0313.1) was applied in patients after gastrectomy to investigate the effect of C. butyricum on the early postoperative recovery by monitoring the inflammatory immune response with blood indicators, detecting the gut microbiota with high-throughput sequencing, and analyzing the short-chain fatty acids (SCFAs) with targeted metabolomics. This study is registered with the number ChiCTR2000040915.ResultsOur outcomes revealed that C. butyricum had significantly reduced the number of Leucocyte (P < 0.001), the percentage of Neutrophil (P < 0.001), the expression of IL-1β (P < 0.01), IL-6 (P < 0.05), and TNF-α (P < 0.01), while markedly enhanced the immunity indexes (immunoglobulin and lymphocyte) (P < 0.05) and nutrition indexes (albumin and total protein) (P < 0.05). In addition, the use of the C. butyricum greatly enriched the relative abundance of beneficial bacteria Bacteroides, Faecalibacterium and Gemmiger, while the abundance of pathogenic Streptococcus, Desulfovibrio and Actinomyces were markedly decreased at genus level. We also observed significant up-regulation of SCFAs, including acetic acid, propionic acid, butyric acid and isobutyric acid, after C. butyricum administration in patients receiving gastrectomy.ConclusionTherefore, evidence supported that oral administration of C. butyricum after gastrectomy can reduce early postoperative inflammation, enhance immune ability, restore intestinal microbiota eubiosis, increase intestinal SCFAs, reduce the occurrence of postoperative complications, and ultimately promote the early recovery of the patient.Clinical trial registrationhttp://www.chictr.org.cn/, identifier (ChiCTR2000040915).

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Section: Discussionmentioning

confidence: 99%

Clostridium butyricum potentially improves inflammation and immunity through alteration of the microbiota and metabolism of gastric cancer patients after gastrectomy

Cao

Zheng

et al. 2022

Front. Immunol.

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“…In recent years, related studies have demonstrated that the inflammatory response (tissue necrosis, activation of immune response, secretion of cytokines) plays an important role in the occurrence, development and metastasis of tumors [ 15 , 16 ]. In clinical practice, medical staff often use various methods such as enteral nutrition support and combined ERAS to adjust the immunity of cancer patients to improve the prognosis of patients [ 17 , 18 ]. In the early stage, the inflammatory response is induced and the anti-tumor immune response is inhibited, thereby promoting growth of tumor cells.…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis between preoperative systemic immune inflammation index and prognosis of patients after radical gastric cancer surgery: based on propensity score matching method

Xiao-bin

et al. 2022

World J Surg Onc

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Background To explore the correlation between the preoperative systemic immune inflammation index (SII) and the prognosis of patients with gastric carcinoma (GC). Methods The clinical data of 771 GC patients surgically treated in the Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital from June 2010 to June 2015 were retrospectively analyzed, and their preoperative SII was calculated. The optimal cut-off value of preoperative SII was determined using the receiver operating characteristic (ROC) curve, the confounding factors between the two groups were eliminated using the propensity score matching (PSM) method, and the correlation between preoperative SII and clinicopathological characteristics was assessed by chi-square test. Moreover, the overall survival was calculated using Kaplan-Meier method, the survival curve was plotted, and log-rank test was performed for the significance analysis between the curves. Univariate and multivariate analyses were also conducted using the Cox proportional hazards model. Results It was determined by the ROC curve that the optimal cut-off value of preoperative SII was 489.52, based on which 771 GC patients were divided into high SII (H-SII) group and low SII (L-SII) group, followed by PSM in the two groups. The results of Kaplan-Meier analysis showed that before and after PSM, the postoperative 1-, 3-, and 5-year survival rates in L-SII group were superior to those in H-SII group, and the overall survival rate had a statistically significant difference between the two groups (P < 0.05). Before PSM, preoperative SII [hazard ratio (HR) = 2.707, 95% confidence interval (CI) 2.074-3.533, P < 0.001] was an independent risk factor for the prognosis of GC patients. After 1:1 PSM, preoperative SII (HR = 2.669, 95%CI 1.881–3.788, P < 0.001) was still an independent risk factor for the prognosis of GC patients. Conclusions Preoperative SII is an independent risk factor for the prognosis of GC patients. The increase in preoperative SII in peripheral blood indicates a worse prognosis.

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“…With advancements in laparoscopic techniques and tools, single-incision laparoscopic surgery (SILS) has also been developed. Some studies have compared operative outcomes among various combinations of surgical methods and conventional or ERAS care [19,20]. Although no difference was observed in complications or readmission rates, the group that received ERAS care demonstrated a significantly shorter LOS than the other two groups receiving conventional perioperative care.…”

Section: ) Surgical Approachmentioning

confidence: 99%

“…In the multivariable analysis, perioperative ERAS care was a significant factor in reducing LOS, while SILS was not. Another study [20] compared SILS and multiport laparoscopic surgery while implementing ERAS perioperative care in gastric cancer cases. However, only the C-reactive protein level was significantly lower in the SILS group on the third postoperative day.…”

Section: ) Surgical Approachmentioning

confidence: 99%

The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery

Kim

2023

Ewha Med J

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Enhanced recovery after surgery (ERAS) aims to promote postoperative recovery in patients by minimizing the surgical stress response through evidence-based multimodal interventions. In 2023, updated clinical practice guidelines were published in North America, potentially superseding the most recent guidelines previously announced at the ERAS Society in 2019. This review compares and reviews these two guidelines to examine the principle of ERAS and items related to colorectal surgery and to introduce the latest relevant study results published within the last 5 years. In the pre-hospitalization stage, the concept of pre-hospitalization is emphasized; this involves checking and reinforcing the patient's nutritional status and physical functional status before surgery. In the preoperative stage, large-scale studies have prompted a change in the recommendation of mechanical bowel preparation combined with oral antibiotics in elective colorectal surgery. In the intraoperative stage, laparoscopic surgery has become a widespread and important component of ERAS, and more technologically advanced single-incision laparoscopic surgery and robotic surgery are the focus of active research. Ileus-prevention items, such as opioid-sparing multimodal pain management and euvolemic fluid therapy, are recommended in the postoperative stage. The adoption of ERAS protocols is expanding to encompass a wide range of surgical procedures, clinical scenarios, healthcare institutions, and professional medical societies. In order to maximize the effect by increasing adherence to ERAS, medical staff must fully understand the clinical basis and meaning of each item, and the protocol must be maintained and developed steadily through a team approach and audit system.

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Effect of single-incision laparoscopic distal gastrectomy guided by ERAS and the influence on immune function

Cited by 7 publications

References 31 publications

Clostridium butyricum potentially improves inflammation and immunity through alteration of the microbiota and metabolism of gastric cancer patients after gastrectomy

Clostridium butyricum potentially improves inflammation and immunity through alteration of the microbiota and metabolism of gastric cancer patients after gastrectomy

Correlation analysis between preoperative systemic immune inflammation index and prognosis of patients after radical gastric cancer surgery: based on propensity score matching method

The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery

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