Effects of Preoperative Use of an Immune-Enhancing Diet on Postoperative Complications and Long-Term Outcome: A Randomized Clinical Trial in Colorectal Cancer Surgery in Japanese Patients

Background: Despite recent advances in surgical techniques and perioperative management, postoperative infectious complications remain a problem in surgical patients. We performed a prospective randomized clinical trial to examine the effects of preoperative Immune Enhancing Diets (IEDs) on postoperative complications in Japanese patients who underwent curative colorectal cancer surgery. This study was also designed to evaluate the optimal dose of preoperative IEDs for the patients without malnutrition. Finally, we analyzed recurrence free survival (RFS) and disease-specific survival (DSS) after surgery in patients who did and did not receive IEDspreoperatively.Material and Methods: This was a prospective, randomized clinical trial conducted at the Department of Surgery, National Defense Medical College, from October 2002 to October 2005. The 88 patients undergoing colorectal surgery were enrolled and were randomly divided into 3 groups. The high- (High, N=26) and low- (Low, N=31) dose groups received normal food and, respectively, 750ml/day or 250ml/ day of IEDs for 5 days before the operation. The primary endpoint was the rates of surgical site infection (SSI) and non- infectious complications. We also evaluated the RFS and DSS rate, respectively. Results: The patients were followed for 77±10 months (9-133 months) after surgery. Incisional SSI rates in the IEDs (High and Low) groups were significantly lower than in the Control group. (0%*, 0%* and 17%) (*P<0.01 vs. Control) The incidences of the infections not involving the surgical site (non-SSI) and the lengths of hospital stay were similar among the three groups. No significant differences were observed in RFS or DSS.Conclusion: In Japanese patients undergoing colorectal cancer surgery, preoperative IEDs significantly reduced the rate of incisional SSI as compared with the control group. Very interestingly, in Japanese patients, preoperative 250ml/day IED intake may be adequate for colorectal cancer patients without malnutrition. However, with regard to the long term outcome, beneficial effects of preoperative IEDs are not evident

Expression of centromere protein F (CENP-F) associated with higher FDG uptake on PET/CT, detected by cDNA microarray, predicts high-risk patients with primary breast cancer

<p>Abstract</p> <p>Background</p> <p>Higher standardized uptake value (SUV) detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) correlates with proliferation of primary breast cancer. The purpose of this study is to identify specific molecules upregulated in primary breast cancers with a high SUV and to examine their clinical significance.</p> <p>Methods</p> <p>We compared mRNA expression profiles between 14 tumors with low SUVs and 24 tumors with high SUVs by cDNA microarray. We identified centromere protein F (CENP-F) and CDC6 were upregulated in tumors with high SUVs. RT-PCR and immunohistochemical analyses were performed to validate these data. Clinical implication of CENP-F and CDC6 was examined for 253 archival breast cancers by the tissue microarray.</p> <p>Results</p> <p>The relative ratios of CENP-F and CDC6 expression levels to β-actin were confirmed to be significantly higher in high SUV tumors than in low SUV tumors (<it>p </it>= 0.027 and 0.025, respectively) by RT-PCR. In immunohistochemical analysis of 47 node-negative tumors, the CENP-F expression was significantly higher in the high SUV tumors (74%) than the low SUV tumors (45%) (<it>p </it>= 0.04), but membranous and cytoplasmic CDC6 expressions did not significantly differ between both groups (<it>p </it>= 0.9 each). By the tissue microarray, CENP-F (HR = 2.94) as well as tumor size (HR = 4.49), nodal positivity (HR = 4.1), and Ki67 (HR = 2.05) showed independent impact on the patients' prognosis.</p> <p>Conclusion</p> <p>High CENP-F expression, correlated with high SUV, was the prognostic indicators of primary breast cancer. Tumoral SUV levels may serve as a pretherapeutic indicator of aggressiveness of breast cancer.</p

Appropriate treadmill exercise improves survival after gut ischemia reperfusion in mice

Summary: Background＆aims: It is unclear whether or not an appropriate prehabilitation protocol ameliorates surgical stress, ultimately improves survival after severe surgical insults. Methods: Male C57BL/6J mice received treadmill exercise according to the following protocols. Exp.1) Sixty-min treadmill running at 20 m/min. The exercise sessions were 5 days/week for 2 weeks, 3 days/week for 2 weeks or 3 days/week for 3 weeks (n = 29). Sedentary mice (n = 6) did not perform treadmill exercise. After finishing each protocol, the exercise completion rate was evaluated. All mice which had completed the protocol (n = 24) underwent 45 min superior mesenteric artery occlusion and reperfusion (Gut I/R) and survival after gut I/R was observed. Exp.2) According to the results of Exp.1, the exercise frequency and duration were set at 3 days/week for 3 weeks. To determine the appropriate running speed, mice (n = 94) ran on the treadmill for 60 min at 12, 15 or 18 m/min, while sedentary mice (n = 25) did not. The exercise completion rate and survival were observed. Results: Exp.1) The 3 days/week for 3 weeks exercise protocol showed the highest survival rate. However, the completion rate of each exercise group was only 50–60%. Exp.2) The completion rates at 15 m/min and 18 m/min were both approximately 90%. None of the 12 m/min group failed to complete the protocol. The 12 m/min and 15 m/min treadmill running groups showed equally improved survival as compared to the sedentary group (p < 0.05). Conclusions: An appropriate exercise protocol improves survival after gut I/R in mice. Prehabilitation strengthens resistance to severe surgical insults. Keywords: Prehabilitation, Gut ischemia reperfusio