Perioperative restricted fluid therapy preserves immunological function in patients with colorectal cancer.
OBJECTIVE
To investigate the effect of perioperative restricted fluid therapy on circulating CD4(+)/CD8(+) T lymphocyte ratio, percentage of regulatory T cells (Treg) and postoperative complications in patients with colorectal cancer.


METHODS
A total of 185 patients met the inclusion criteria and were included in the randomized clinical trial. These patients were divided into two groups according to receipt of either perioperative standard (S, n = 89) or restricted (R, n = 96) fluid therapy. Clinical data of these patients were collected in this prospective study. Perioperative complications and cellular immunity changes (CD4(+)/CD8(+) and Treg) were analyzed comparatively between the two groups.


RESULTS
Both during surgery and on postoperative days, the total volumes of fluids administered in the R group were significantly lower than those in the S group (1620 ± 430 mL vs 3110 ± 840 mL; 2090 ± 360 mL vs 2750 ± 570 mL; 1750 ± 260 mL vs 2740 ± 490 mL; 1620 ± 310 mL vs 2520 ± 300 mL; P < 0.05). Decreased ratios of circulating CD4(+)/CD8(+) T lymphocytes (1.47 ± 0.28 vs 2.13 ± 0.26; 1.39 ± 0.32 vs 2.21 ± 0.24; P < 0.05) and Treg percentage values (2.79 ± 1.24 vs 4.26 ± 1.04; 2.46 ± 0.98 vs 4.30 ± 1.12; P < 0.05) were observed after surgery in both groups. However, in the R group, these values restored more quickly starting from postoperative day 2 (1.44 ± 0.24 vs 1.34 ± 0.27; 2.93 ± 1.08 vs 2.52 ± 0.96; P < 0.05). The proportion of patients with complications was significantly lower in the restricted group (36 of 89 vs 59 of 96, P < 0.01).


CONCLUSIONS
Perioperative restricted intravenous fluid regimen leads to a low postoperative complication rate and better cellular immunity preservation in patients with colorectal cancer.
Hong-Ying Jie, Ji-Lu Ye, Department of Intensive Care Unit, Taizhou People's Hospital, Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China.
Hong-Ying
HY
Jie
Hong-Ying Jie, Ji-Lu Ye, Department of Intensive Care Unit, Taizhou People's Hospital, Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China.
Ji-Lu
JL
Ye
Hong-Ying Jie, Ji-Lu Ye, Department of Intensive Care Unit, Taizhou People's Hospital, Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China.
Hai-Hua
HH
Zhou
Hong-Ying Jie, Ji-Lu Ye, Department of Intensive Care Unit, Taizhou People's Hospital, Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China.
Yun-Xiang
YX
Li
D000368:Aged; D000369:Aged, 80 and over; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D002681:China; D003082:Colectomy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control*; D011446:Prospective Studies; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome
D006895:Hydroxyethyl Starch Derivatives
Colorectal cancer; Immunological function; Postoperative complications; Restricted fluid therapy; Standard fluid therapy