Fast-track surgery improves postoperative clinical recovery and reduces postoperative insulin resistance after esophagectomy for esophageal cancer.
OBJECTIVE
This study aims to investigate the influence of fast-track surgery (FTS) on insulin resistance indicators in a prospective randomized, controlled clinical trial in esophageal cancer patients.


METHODS
Between November 2009 and March 2011, 34 patients underwent the FTS pathway, and 34 patients underwent the conventional pathway after esophagectomy in our department. The times to postoperative flatus and defecation, duration of postoperative hospital stay, hospitalization expenditures, and postoperative complications were recorded. Insulin resistance indicators were measured before operation as well as on the 1st, 3rd, and 7th postoperative days (PODs), including serum levels of fasting blood glucose (FBG), fasting insulin (FINS), interleukin-6 (IL-6), and C-reactive protein (CRP) in patients of both groups. The insulin resistance index (homeostasis model assessment of insulin resistance (HOMA-IR)) was calculated at each time point.


RESULTS
We found a significantly shorter postoperative hospital stay and faster return of gastrointestinal function in patients who underwent FTS (P < 0.01). In addition, the total hospitalization expenditure was significantly lower in the FTS group (P < 0.01). The preoperative insulin resistance indicators showed no significant differences between the two groups. On PODs 1 and 3, the levels of log-HOMA-IR, FINS, IL-6, and CRP in the FTS group were significantly lower than those in the control group (all P < 0.05). On POD 7, the CRP level in the FTS group was significantly lower than that in the control group (P < 0.05).


CONCLUSIONS
FTS promotes early recovery of gastrointestinal function and reduces stress reaction and postoperative insulin resistance after esophagectomy for esophageal cancer.
Department of Thoracic Surgery, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, 150001, Heilongjiang Province, China.
Guibin
G
Zhao
Shouqiang
S
Cao
Jian
J
Cui
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D004938:Esophageal Neoplasms / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control; D011184:Postoperative Period; D011446:Prospective Studies
D001786:Blood Glucose; D015850:Interleukin-6; D002097:C-Reactive Protein