[Effect of intraoperative intraperitoneal chemotherapy and postoperative nutritional support on intestinal permeability and cellular immune function in patients with advanced gastric cancer].
OBJECTIVE
To investigate the effect of hyperthermic intraoperative intraperitoneal chemotherapy(HIIC) and postoperative nutritional support on the intestinal permeability and the cellular immunity function in patients with advanced gastric cancer.


METHODS
All the patients diagnosed as advanced gastric cancer in the Gastric Tumor Diagnosis and Treatment Center of Jiangsu Cancer Hospital were randomly divided into three groups using random digit table:(1)EN group treated with enteral nutrition during postoperative period; (2)HIIC+EN group treated with HIIC combined with postoperative enteral nutrition;(3)HIIC+PN group treated with HIIC combined with postoperative parenteral nutrition. Index of lactulose/mannitol(L/M) ratio was used to evaluate the permeability of intestinal mucosa. The percentage of CD4(+), CD8(+) and NK cell, the ratio of CD4/CD8 T cell in peripheral blood were tested by flow cytometry. The time points of these measurements were the day before surgery, postoperative days (POD) 3, 7, and 12.


RESULTS
Compared with the day before surgery(POD-1), the ratio of L/M on POD+3 increased significantly in all the three groups(0.1235±0.0611 vs. 0.0280±0.0183, 0.1648±0.0571 vs. 0.0305±0.0208, 0.1702±0.0628 vs. 0.0298±0.0229)(P<0.05) and then decreased gradually. The L/M ratio of EN(0.0278±0.0217) and HIIC+EN(0.0336±0.0235) groups recovered to the baseline on POD+12, however HIIC+PN group still had elevated L/M ratio(0.0616±0.0430). The percentage of CD4(+)T cell and the ratio of CD4/CD8 in HIIC+EN group and HIIC+PN group were significantly lower than those in EN group(P=0.033, P=0.002, respectively). Compared with the POD-1,the percentage of CD4(+)T cell and the ratio of CD4/CD8 in HIIC+EN group and EN group on POD+12 were increased significantly(P<0.05).


CONCLUSIONS
HIIC may cause significant increase in intestinal permeability and inhibit cellular immunity in patients undergoing radical resection for advanced gastric cancer. Mucosal permeability can be reversed by enteral nutrition.
Department of General Surgery, Jiangsu Cancer Hospital, Nanjing, China.
Rong-min
RM
Gu
Xu
X
Wen
Da
D
Wei
Xue-zhi
XZ
Ming
Gang
G
Li
Huan-qiu
HQ
Chen
D034841:Abdominal Cavity; D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007413:Intestinal Mucosa / Q000276:immunology / Q000503:physiopathology; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000379:methods*; D010539:Permeability; D011184:Postoperative Period; D013274:Stomach Neoplasms / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*