THE INFLUENCE OF THE PREOPERATIVE PRELOAD WITH CARBOHYDRATES UPON METABOLIC, IMMUNE AND CYTOKINE STATUSES AFTER RECONSTRUCTIVE ESOPHAGEAL SURGICAL INTERVENTIONS

• Published in: Medit͡s︡inskai͡a︡ immunologii͡a 2018-01, Vol.20 (6), p.877
• Main Authors: Tarasova, I A, Inviyaeva, E V, Bunyatyan, K A, Tskhovrebov, A T, Nikoda, V V, Shestakov, A L
• Format: Article
• Language: Russian
• Subjects: Age; Carbohydrates; Dextrose; Dysphagia; Esophagus; Hyperglycemia; Immune response; Inflammation; Insulin; Interleukin 10; Interleukin 6; Interleukin 8; Maltodextrin; Metabolism; Morbidity; Surgery
• ISSN: 1563-0625; 2313-741X
• DOI: 10.15789/1563-0625-2018-6-877-888

The aim of this prospective randomized clinical study was to investigate the role of preoperativecarbohydrate admnistration in surgery-induced metabolic, immune and inflammatory reactions after thoracoabdominaloperations. At the Surgical department I (B.V. Petrovsky National Research Center of Surgery),we investigated a modulatory role of carbohydrate preload upon surgical stress observed after major thoracoabdominaloperations (thoracoscopic and open esophagectomy, retrosternal colonic esophagoplasty) followedby the enhanced recovery protocol. The study was performed in 2014-2017, it included 30 patients, dividedinto 2 groups. Group A patients (n = 16) received carbohydrates preload (12.5% maltodextrin solution per osor enterally). In patients with dysphagia, the 12.5% dextrose solution was used intravenously in equal volumes.Group B patients didn’t receive any additional preload with carbohydrates. The groups were age- and gendermatched,similar for disease and surgery types. Glucose and insulin levels (with HOMA insulin resistanceindex, HOMA-IR) were measured before surgery and on day +1, interleukin levels (IL-6, IL-10, IL-8) andindex IL-8/IL-10 were assessed before surgery, and on days +1 and +5 after surgery. Cell-mediated immunitywas investigated before surgery and on day +5. The stress-induced hyperglycemia (> 7.8 mmol/L) was detected more frequently in group B (50%), than ingroup A (6%), p = 0.012. Insulin resistance measured by HOMA-IR in group B was detected in 71% of patientsand in 25% patients of group A only, p = 0.027. Individual analysis of immune response demonstrated that atrend for immune recovery was detected by the day +5 post-op in the group A. Postoperative levels of IL-6 andIL-10 were lower on day +1 and +5 in group A. Morbidity rates and the terms of hospitalization were similarin both groups. Local postsurgical infections in group A were developed in 6% of the patients vs 35.6% in groupB (p = 0.072). In conclusion, a complex study of surgical stress, i.e., metabolic, immune and inflammatory reactionsafter esophageal surgery has shown that the carbohydrate preload decreased the incidence of postoperativeinsulin resistance and stress-induced hyperglycemia, being accompanied by lower release of proinflammatorycytokines and provides positive effects upon the patient’s immune system.