title: Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer.
abstract: Our aim was to investigate the influence of FTS on human cellular and humoral immunity using a randomized controlled clinical study in esophageal cancer patients.
  
  
  
  Between October 2013 and December 2014, 276 patients with esophageal cancer in our department were enrolled in the study. The patients were randomized into two groups: FTS pathway group and conventional pathway group. The postoperative hospital stay, hospitalization expenditure, and postoperative complications were recorded. The markers of inflammatory and immune function were measured before operation as well as on the 1st, 3rd, and 7th postoperative days (POD), including serum level of interleukin-6 (IL-6), C-reactive protein (CRP), serum globulin, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA) and lymphocyte subpopulations (CD3 lymphocytes, CD4 lymphocytes, CD8 lymphocytes and the CD4/CD8 ratio) in the patients between the two groups.
  
  
  
  In all, 260 patients completed the study: 128 in the FTS group and 132 in the conventional group. We found implementation of FTS pathway decreases postoperative length of stay and hospital charges (P < 0.05). In addition, inflammatory reactions, based on IL-6 and CRP levels, were less intense following FTS pathway compared to conventional pathway on POD1 and POD3 (P < 0.05). On POD1 and POD3, the levels of IgG, IgA, CD3 lymphocytes, CD4 lymphocytes and the CD4/CD8 ratio in FTS group were significantly higher than those in control group (All P < 0.05). However, there were no differences in the level of IgM and CD8 lymphocytes between the two groups.
  
  
  
  FTS improves postoperative clinical recovery and effectively inhibited release of inflammatory factors via the immune system after esophagectomy for esophageal cancer.
  
  
  
  ChiCTR-TRC-13003562 , the date of registration: August 29, 2013.
authors.affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.
authors.forename: Lantao
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.
authors.forename: Yaoguo
authors.initials: Y
authors.lastname: Lang
authors.affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.|Department of Thoracic Surgery, Hainan Cancer Hospital, Haikou, Hainan Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yao
authors.affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Ning
authors.affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China. xwkxsd@outlook.com.
authors.forename: Shidong
authors.initials: S
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004938:Esophageal Neoplasms / Q000276:immunology* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007249:Inflammation / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D015850:Interleukin-6; D002097:C-Reactive Protein
keywords: Cellular immunity; Esophageal cancer; Fast-track surgery; Humoral immunity