title: Laparoscopic surgery contributes more to nutritional and immunologic recovery than fast-track care in colorectal cancer.
abstract: BACKGROUND
  Many clinical trials had repeatedly shown that fast-track perioperative care and laparoscopic surgery are both preferred in the treatment of colorectal cancer. But few studies were designed to explore the diverse biochemical impacts of the two counterparts on human immunologic and nutritional status.
  
  
  METHODS
  Ninety-two cases of colorectal cancer patients meeting the inclusion criteria were randomized to four groups: laparoscopy with fast-track treatment (LAFT); open surgery with fast-track treatment (OSFT); laparoscopy with conventional treatment (LAC); open surgery with conventional treatment (OSC). Peripheral blood tests including nutritional factors (albumin, prealbumin, and transferrin), humoral immunologic factors (IgG, IgM, and IgA), and cellular immunologic factors (T and NK cells) were evaluated. Blood samples were collected preoperatively (baseline) and 12 and 96 h after surgery (indicated as POH12 and POH96, respectively).
  
  
  RESULTS
  Albumin, transferrin, prealbumin, and IgG levels were the highest in the LAFT group for both POH12 and POH96 time intervals. Repeated measures (two-way ANOVA) indicated that the difference of albumin, transferrin, and IgG level were attributed to surgery type (P < 0.05) and not perioperative treatment (P > 0.05). Only in the laparoscopy-included groups, the relative albumin and IgG levels of POH96 were obviously higher than that of POH12.
  
  
  CONCLUSIONS
  Laparoscopic surgery accelerated postoperative nutrition and immune levels rising again while fast-track treatment retarded the drop of postoperative nutrition and immune levels. Laparoscopic surgery might play a more important role than fast-track treatment in the earlier postoperative recovery of nutritional and immunologic status. Combined laparoscopic surgery with fast-track treatment provided best postoperative recovery of nutrition and immune status. These results should be further compared with the clinical outcomes of our FTMDT trial (clinicaltrials.gov: NCT01080547).
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. xudongzju@zju.edu.cn.
authors: Dong
authors: D
authors: Xu
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. lj6088@gmail.com.
authors: Jun
authors: J
authors: Li
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. pandasym@163.com.
authors: Yongmao
authors: Y
authors: Song
authors: Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China. doctor.jojozhou.forwork@gmail.com.
authors: Jiaojiao
authors: J
authors: Zhou
authors: Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China. sun77@zju.edu.cn.
authors: Fangfang
authors: F
authors: Sun
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. wangyiwangxiao@126.com.
authors: Jianwei
authors: J
authors: Wang
authors: Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China. dy02@zju.edu.cn.
authors: Yin
authors: Y
authors: Duan
authors: Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China. windyhyt@163.com.
authors: Yeting
authors: Y
authors: Hu
authors: Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China. lywawj@163.com.
authors: Yue
authors: Y
authors: Liu
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. wangxiaochen@zju.edu.cn.
authors: Xiaochen
authors: X
authors: Wang
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. sunlifengzju@gmail.com.
authors: Lifeng
authors: L
authors: Sun
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. 104112030@qq.com.
authors: Linshan
authors: L
authors: Wu
authors: Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Zhejiang, China. dingkefeng@zju.edu.cn.|Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China. dingkefeng@zju.edu.cn.
authors: Kefeng
authors: K
authors: Ding
mesh_terms: D000368:Aged; D000418:Albumins / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism*; D015179:Colorectal Neoplasms / Q000276:immunology* / Q000378:metabolism* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology*; D007070:Immunoglobulin A / Q000378:metabolism; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D007694:Killer Cells, Natural / Q000276:immunology; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009752:Nutritional Status; D019990:Perioperative Care; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D000418:Albumins; D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M
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