Treatment with growth hormone, somatostatin, and insulin in combination with hypocaloric parenteral nutrition in gastrointestinal cancer patients after surgery.
OBJECTIVE
The metabolic response to gastrointestinal cancer in patients undergoing surgery is associated with hypermetabolism and insulin resistance. The potential use of synergetic anabolic hormones in conjunction with hypocaloric parenteral nutrition (HPN) has become a significant area of investigation. The presented study was performed to determine the clinical efficiency and safety of hormone therapy combined with HPN in patients with gastrointestinal cancer.


METHODS
One hundred patients with a Nutrition Risk Screening score of 3 or 4 undergoing surgery for gastrointestinal cancer were randomized into two groups. The patients in the control group received standard total parenteral nutrition and systemic insulin. The patients in the study group received HPN and systemic insulin in addition to pretreatment with recombinant human growth hormone and octreotide. Clinical efficiency and safety were evaluated by the measurement of hormones and protein metabolites, immune function, clinical outcome, and adverse events. Follow-ups were performed to determine the influence on prognosis.


RESULTS
Treatment with recombinant human growth hormone, octreotide, and insulin in combination with HPN significantly increased protein synthesis, immune function, and metabolic tolerance, decreased infectious complications, and shortened postoperative hospital stays, but did not increase the risk of tumor development and recurrence in the study group compared with the control group.


CONCLUSIONS
The proper short-term perioperative administration of growth hormone, somatostatin, and insulin in combination with HPN can overcome the postoperative stress response through the increase of protein synthesis to improve immune function in patients with gastrointestinal cancer after surgery.
Liu
Quanyan
Q
Department of General Surgery, Research Center of Digestive Diseases, Zhong-Nan Hospital, Wuhan University, Wuhan, People's Republic of China.
Liu
Zhisu
Z
Chen
Hongliu
H
Ma
Lu
L
Liu
Li
L
Zhang
Jun
J
He
Yueming
Y
Chen
Jiwei
J
Qian
Qun
Q
D000328:Adult; D000368:Aged; D045930:Anabolic Agents / Q000009:adverse effects / Q000627:therapeutic use; D031204:Caloric Restriction / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000178:diet therapy* / Q000188:drug therapy* / Q000601:surgery; D019382:Human Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D007333:Insulin Resistance; D061389:Insulin, Regular, Pork; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D014176:Protein Biosynthesis / Q000187:drug effects; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013004:Somatostatin / Q000031:analogs & derivatives; D013312:Stress, Physiological / Q000187:drug effects / Q000276:immunology; D016019:Survival Analysis
D045930:Anabolic Agents; D007328:Insulin; D061389:Insulin, Regular, Pork; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D013004:Somatostatin; C000006:insulin, neutral; D015282:Octreotide