Randomized Clinical Trial
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World J Gastroenterol. Nov 14, 2014; 20(42): 15852-15859
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15852
Perioperative restricted fluid therapy preserves immunological function in patients with colorectal cancer
Hong-Ying Jie, Ji-Lu Ye, Hai-Hua Zhou, Yun-Xiang Li
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 Zhou, Department of General Surgery, Taizhou People’s Hospital, Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China
Yun-Xiang Li, Department of Anesthesiology, Taizhou People’s Hospital, Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China
Author contributions: Li YX, Jie HY and Ye JL designed the study; Jie HY, Zhou HH and Ye JL performed the study; Jie HY and Li YX analyzed the data; Jie HY and Li YX wrote and revised the paper.
Correspondence to: Yun-Xiang Li, MD, Department of Anesthesiology, Taizhou People’s Hospital, Medical School of Nantong University, No. 210 East Yingchun Road, Taizhou 225300, Jiangsu Province, China. drliyunxiang@163.com
Telephone: +86-523-86361607 Fax: +86-523-86361324
Received: April 10, 2014
Revised: June 8, 2014
Accepted: July 11, 2014
Published online: November 14, 2014
Abstract

AIM: 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).

CONCLUSION: Perioperative restricted intravenous fluid regimen leads to a low postoperative complication rate and better cellular immunity preservation in patients with colorectal cancer.

Keywords: Colorectal cancer, Restricted fluid therapy, Standard fluid therapy, Postoperative complications, Immunological function

Core tip: This prospective study revealed that perioperative restricted intravenous fluid regimen results in a low postoperative complication rate and better preservation of cellular immunity, which at least in part, explains the improved postoperative clinical outcomes associated with the restricted fluid regimen in patients with colorectal cancer.