title: Lack of preoperative enteral nutrition reduces gut-associated lymphoid cell numbers in colon cancer patients: a possible mechanism underlying increased postoperative infectious complications during parenteral nutrition.
abstract: OBJECTIVE
  To examine preoperative dietary influences on gut-associated lymphoid tissue (GALT) cell number in the context of postoperative infectious complications.
  
  
  BACKGROUND
  There is little clinical evidence regarding whether nutritional routes affect GALT size and/or phenotype. The influence of GALT atrophy on clinical outcomes is also unclear.
  
  
  METHODS
  Patients with complete obstruction of the colon due to a tumor were excluded from this study. Study 1. Resected terminal ileum specimens, from 62 patients [preoperative parenteral nutrition (PN): n = 15, preoperative oral feeding (OF): n = 47] who underwent right colectomy during the period from 1997 to 2004 at our department, were immunohistochemically stained for counting numbers of T, IgA-producing, and mature and immature dendritic cells (DCs) in the lamina propria (LP) and intraepithelial space.Study 2. We reviewed 341 patients (PN: n = 99, OF: n = 242) with colon cancer who underwent colectomy during this period for postoperative complications.
  
  
  RESULTS
  Study 1. T cell numbers in the LP and intraepithelial space and IgA-producing cell number in the LP were significantly lower in the PN than in the OF group. Mature DC number in the LP was significantly lower in the PN than in the OF group, whereas total DC numbers (both mature and immature DC) were similar in the 2 groups.Study 2. The PN group had significantly higher rates of total infectious complications, surgical site infection, pneumonia, infectious colitis, and central venous catheter infection.
  
  
  CONCLUSIONS
  Lack of enteral delivery of nutrients reduces numbers of T and IgA-producing cells, as well as mature DCs, in GALT of colon cancer patients, as it does in animal models. A close association between GALT changes and infectious complication morbidity was confirmed.
authors.affiliation: *Department of Surgery, National Defense Medical College, Saitama †Surgical center, the University of Tokyo ‡Department of Surgery, Teikyo University School of Medicine, Tokyo §Division of Basic Traumatology, National Defense Medical College Research Institute, Saitama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Okamoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukatsu
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Hashiguchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
authors.forename: Eiji
authors.initials: E
authors.lastname: Shinto
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Moriya
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
mesh_terms: D000368:Aged; D002452:Cell Count; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007422:Intestines / Q000473:pathology*; D008214:Lymphocytes; D008297:Male; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D012189:Retrospective Studies