Enhanced recovery after surgery for gastric cancer and an assessment of preoperative carbohydrate loading.

BACKGROUND: We previously reported on the feasibility of enhanced recovery after surgery (ERAS) protocol for gastric cancer with a prospective phase II study, but the superiority of this approach over non-ERAS perioperative management remains unclear. Preoperative carbohydrate loading, an important element of the ERAS protocol, has been shown to reduce insulin resistance, but its effects on clinical endpoints in gastric cancer surgery remain controversial. The aim of this study was to clarify the efficacy of the ERAS protocol for gastric cancer surgery, with particular focus on preoperative carbohydrate loading. METHODS: In this ERAS case-control study, we enrolled 121 patients as a case group and 259 patients undergoing gastrectomy for gastric cancer with our conventional perioperative management as a control group. Matched-pair analysis was performed to balance the patients' characteristics for comparison analysis. RESULTS: After matching, 108 patients were included in each group. Postoperative hospital stay was significantly shorter in the ERAS group than in the control group (8 days vs. 9 days, p < 0.001), while the incidence of Clavien-Dindo classification grade II or more postoperative complication was similar between the groups (11.1% vs. 15.7%, p = 0.325). No significant differences were found in serum albumin level, body weight, or grip strength between the groups before surgery and at 1 week and 1 month after surgery. CONCLUSION: Use of the ERAS protocol for gastric cancer shortened the length of postoperative hospital stay without increasing complications. Preoperative carbohydrate loading didn't improve the postoperative nutritional status or maintain the muscle strength postoperatively.

NADPH oxidase subunit, gp91(phox) homologue, preferentially expressed in human colon epithelial cells.

The NADPH oxidases are a group of plasma membrane-associated enzymes found in a variety of cells. They catalyze the production of superoxide (O(-)(2)) by a one-electron reduction of oxygen, using NADPH as the electron donor. To characterize the expression of this enzyme, two homologues of the NADPH oxidase catalytic subunit, gp91(phox), were cloned from the cDNAs of a human colon cancer cell line, Caco2, and human fetal kidney, using information relating to an expressed sequence tag (EST) from a DNA database. Amino acid identity was 58% (gp91-2) and 56% (gp91-3), respectively, against the catalytic subunit (gp91-1/gp91(phox)) of the NADPH oxidase found in peripheral blood leukocytes. Using the reverse transcription-polymerase chain reaction (RT-PCR) method, the messenger RNA of gp91-2 was detected mainly in the colon (and also in kidney and prostate) among human adult tissues, in the thymus among human fetal tissues, and in the cancer cell lines (HepG2 and Caco2). An expression of gp91-3 was detected in the fetal kidney, and in the cancer cell line (HepG2), but not at all in adult tissues (by the RT-PCR method). In situ hybridization revealed that gp91-2 is located in the absorptive epithelial cells of the adult colon. Neither gp91-2 nor gp91-3 was expressed in peripheral blood leukocytes.