Abstract
Background
We clarified the effects of perioperative enteral supplementation with glutamine, fiber, and oligosaccharide (GFO) after an esophagectomy on preventing surgical stress.
Methods
Of 326 patients with esophageal cancer, 189 received GFO administration (GFO group) and 137 did not (control group). The propensity score matching method was used to identify 89 well-balanced pairs of patients to compare postoperative laboratory parameters and clinical and postoperative outcomes.
Results
The duration of the systemic inflammatory response syndrome (SIRS) was significantly shorter in the GFO group compared to the control group (p = 0.002). Moreover, the lymphocyte/neutrophil ratio (L/N ratio) had significantly recovered in the GFO group on postoperative day-3, and the CRP value was significantly lower in the GFO group than that in the control group on postoperative day-2.
Conclusions
Perioperative use of enteral supplementation with glutamine, fiber, and oligosaccharide likely contributes to a reduction in early surgical stress after an esophagectomy. These beneficial effects can bring about early recovery from postoperative immunosuppressive conditions after radical esophagectomy.
Similar content being viewed by others
References
Lerut T, Moons J, Coosemans W, et al. Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg. 2009;250(5):798–807.
Matsubara T, Ueda M, Nagao N, et al. Surgical treatment for carcinoma of the thoracic esophagus with major involvement in the neck or upper mediastinum. J Surg Oncol. 1998;67(1):6–10.
Igaki H, Tachimori Y, Kato H. Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg. 2004;239(4):483–90.
Sato N, Koeda K, Ikeda K, et al. Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg. 2002;236(2):184–90.
Kooguchi K, Kobayashi A, Kitamura Y, et al. Elevated expression of inducible nitric oxide synthase and inflammatory cytokines in the alveolar macrophages after esophagectomy. Crit Care Med. 2002;30(1):71–6.
van Sandick JW, Gisbertz SS, ten Berge IJ, et al. Immune responses and prediction of major infection in patients undergoing transhiatal or transthoracic esophagectomy for cancer. Ann Surg. 2003;237(1):35–43.
Okamura A, Takeuchi H, Matsuda S, et al. Factors affecting cytokine change after esophagectomy for esophageal cancer. Ann Surg Oncol. 2015;22(9):3130–5.
Dabrowska AM, Slotwinski R. The immune response to surgery and infection. Central Eur J Immunol. 2014;39(4):532–7.
Kobayashi K, Koyama Y, Kosugi S, et al. Is early enteral nutrition better for postoperative course in esophageal cancer patients? Nutrients. 2013;5(9):3461–9.
Palanivelu C, Prakash A, Senthilkumar R, et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients. J Am Coll Surg. 2006;203(1):7–16.
Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet (London, England). 2012;379(9829):1887–92.
Li C, Ferri LE, Mulder DS, et al. An enhanced recovery pathway decreases duration of stay after esophagectomy. Surgery. 2012;152(4):606–14 (discussion 14–6).
Weijs TJ, Dieleman JM, Ruurda JP, et al. The effect of perioperative administration of glucocorticoids on pulmonary complications after transthoracic oesophagectomy: a systematic review and meta-analysis. Eur J Anaesthesiol. 2014;31(12):685–94.
Shimizu K, Ogura H, Goto M, et al. Altered gut flora and environment in patients with severe SIRS. J Trauma. 2006;60(1):126–33.
Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology (Baltimore, Md). 2005;41(3):422–33.
Deitch EA, Bridges RM. Effect of stress and trauma on bacterial translocation from the gut. J Surg Res. 1987;42(5):536–42.
Mizuno T, Yokoyama Y, Nishio H, et al. Intraoperative bacterial translocation detected by bacterium-specific ribosomal rna-targeted reverse-transcriptase polymerase chain reaction for the mesenteric lymph node strongly predicts postoperative infectious complications after major hepatectomy for biliary malignancies. Ann Surg. 2010;252(6):1013–9.
Nishigaki E, Abe T, Yokoyama Y, et al. The detection of intraoperative bacterial translocation in the mesenteric lymph nodes is useful in predicting patients at high risk for postoperative infectious complications after esophagectomy. Ann Surg. 2014;259(3):477–84.
Takechi H, Mawatari K, Harada N, et al. Glutamine protects the small intestinal mucosa in anticancer drug-induced rat enteritis model. J Med Investig (JMI). 2014;61(1–2):59–64.
van der Hulst RR, von Meyenfeldt MF, Tiebosch A, et al. Glutamine and intestinal immune cells in humans. JPEN J Parenter Enter Nutr. 1997;21(6):310–5.
Chun H, Sasaki M, Fujiyama Y, et al. Effect of enteral glutamine on intestinal permeability and bacterial translocation after abdominal radiation injury in rats. J Gastroenterol. 1997;32(2):189–95.
Hardy H, Harris J, Lyon E, et al. Probiotics, prebiotics and immunomodulation of gut mucosal defences: homeostasis and immunopathology. Nutrients. 2013;5(6):1869–912.
Rice TW, Rusch VW, Ishwaran H, et al. Cancer of the esophagus and esophagogastric junction: data-driven staging for the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Staging Manuals. Cancer. 2010;116(16):3763–73.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Joo E, Muraoka A, Hamasaki A, et al. Enteral supplementation with glutamine, fiber, and oligosaccharide modulates incretin and glucagon-like peptide-2 secretion. J Diabetes Investig. 2015;6(3):302–8.
Iyama S, Sato T, Tatsumi H, et al. Efficacy of enteral supplementation enriched with glutamine, fiber, and oligosaccharide on mucosal injury following hematopoietic stem cell transplantation. Case Rep Oncol. 2014;7(3):692–9.
Higashiguchi TIA, Futamura A, Kodama Y, et al. Effects of GFO on the pathological and functional changes in the intestinal mucosa associated with total parenteral nutrition in rats. Jpn J Surg Metab Nutr. 2009;43:51–60.
Marton S, Ghosh S, Papp A, et al. Effect of glutamine in patients with esophagus resection. Dis Esophagus. 2010;23(2):106–11.
van Zanten AR, Dhaliwal R, Garrel D, et al. Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis. Crit Care. 2015;19:294.
Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995;125(6):1401–12.
Sugawara G, Nagino M, Nishio H, et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg. 2006;244(5):706–14.
Tanaka K, Yano M, Motoori M, et al. Impact of perioperative administration of synbiotics in patients with esophageal cancer undergoing esophagectomy: a prospective randomized controlled trial. Surgery. 2012;152(5):832–42.
Yokoyama Y, Nishigaki E, Abe T, et al. Randomized clinical trial of the effect of perioperative synbiotics versus no synbiotics on bacterial translocation after oesophagectomy. Br J Surg. 2014;101(3):189–99.
Reddy BS, Macfie J, Gatt M, et al. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg. 2007;94(5):546–54.
Eguchi S, Takatsuki M, Hidaka M, et al. Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation: a prospective randomized study. Am J Surg. 2011;201(4):498–502.
Acknowledgements
The authors thank Professor Kenichi Yoshimura (Innovative Clinical Research Center, Kanazawa University) for guidance on statistical analysis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical statement
This was a retrospective study approved by the review board of the Aichi Cancer Center Hospital.
Conflict of interest
The authors have no conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Abe, T., Hosoi, T., Kawai, R. et al. Perioperative enteral supplementation with glutamine, fiber, and oligosaccharide reduces early postoperative surgical stress following esophagectomy for esophageal cancer. Esophagus 16, 63–70 (2019). https://doi.org/10.1007/s10388-018-0630-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-018-0630-z