Xia LC, Zhang K, Wang CW. Effects of fluid therapy combined with a preoperative glucose load regimen on postoperative recovery in patients with rectal cancer. World J Gastrointest Surg 2024; 16(8): 2662-2670 [PMID: 39220080 DOI: 10.4240/wjgs.v16.i8.2662]
Corresponding Author of This Article
Ke Zhang, MMed, Attending Doctor, Department of Emergency Medicine, Jiujiang First People's Hospital, No. 48 Taling South Road, Xunyang District, Jiujiang 332000, Jiangxi Province, China. zk18720166866@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2662-2670 Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2662
Effects of fluid therapy combined with a preoperative glucose load regimen on postoperative recovery in patients with rectal cancer
Lv-Chi Xia, Ke Zhang, Chuan-Wen Wang
Lv-Chi Xia, Ke Zhang, Chuan-Wen Wang, Department of Emergency Medicine, Jiujiang First People's Hospital, Jiujiang 332000, Jiangxi Province, China
Author contributions: Xia LC designed the research study; Xia LC, Zhang K, and Wang CW performed the primary literature and data extraction; Xia LC, Zhang K, and Wang CW analyzed the data and wrote the manuscript; Xia LC was responsible for revising the manuscript for important intellectual content; all authors read and approved the final version.
Institutional review board statement: The study was reviewed and approved by the Science and Research Office of the Jiujiang Municipal First People's Hospital.
Clinical trial registration statement: The study was registered at the Clinical Trial Center with registration number: Researchregistry10373.
Informed consent statement: All study participants or their legal guardians provided informed written consent before enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ke Zhang, MMed, Attending Doctor, Department of Emergency Medicine, Jiujiang First People's Hospital, No. 48 Taling South Road, Xunyang District, Jiujiang 332000, Jiangxi Province, China. zk18720166866@126.com
Received: May 7, 2024 Revised: June 8, 2024 Accepted: July 1, 2024 Published online: August 27, 2024 Processing time: 101 Days and 3.9 Hours
Abstract
BACKGROUND
Patients with rectal cancer undergoing radical resection often have poor postoperative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue, and have a high risk of complications. Therefore, it is of great significance to apply appropriate rehydration regimens to patients undergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of patients.
AIM
To analyze the effects of goal-directed fluid therapy (GDFT) with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal cancer.
METHODS
Patients with rectal cancer who underwent radical resection (n = 184) between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group (n = 92 in each group). Both groups received a preoperative glucose load regimen, and routine fluid replacement and GDFT were additionally implements in the control and observation groups, respectively. The operative conditions, blood levels of lactic acid and inflammatory markers, postoperative recovery, cognitive status, hemodynamic indicators, brain oxygen metabolism, and complication rates were compared between the groups.
RESULTS
The colloidal fluid dosage, total infusion, and urine volume, as well as time to first exhaust, time to food intake, and postoperative length of hospital stay, were lower in the observation group (P < 0.05). No significant differences were observed between the two groups in terms of operation time, bleeding volume, crystalloid liquid consumption, time to tracheal extubation, complication rate, heart rate, or mean arterial pressure (P > 0.05). Compared with the control group, in the observation group the lactic acid level was lower immediately after the surgery (P < 0.05); the Mini-Mental State Examination score was higher on postoperative day 3 (P < 0.05); the pulse pressure variability (PPV) was lower at 30 min after pneumoperitoneum (P < 0.05), though the differences in the PPV of the two groups was not significant at the remaining time points (P > 0.05); tumor necrosis factor-α and interleukin-6 levels were lower on postoperative day 3 (P < 0.05); and the left and right regional cerebral oxygen saturation was higher immediately after the surgery and 30 min after pneumoperitoneum (P < 0.05).
CONCLUSION
GDFT combined with the preoperative glucose load regimen is a safe and effective treatment strategy for improving postoperative recovery and risk of complications in patients with rectal cancer undergoing radical resection.
Core Tip: The application of goal-directed fluid therapy combined with a preoperative glucose load regimen in patients with rectal cancer undergoing radical resection can not only significantly improve the postoperative recovery and brain tissue oxygen metabolism, but also alleviate inflammatory reactions, and improve cognitive function, hemodynamics, and blood lactate levels. This study observed the postoperative recovery of patients undergoing radical resection for rectal cancer, and confirmed the effectiveness of goal-directed fluid therapy combined with a preoperative glucose load regimen in patients undergoing radical resection for rectal cancer.
