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Anti-inflammatory Effects of Enhanced Recovery Programs on Early-Stage Colorectal Cancer Surgery.
Venara, Aurélien; Duchalais, Emilie; Dariel, Anne; Aubert, Philippe; Durand, Tony; Meurette, Guillaume; Rolli-Derkinderen, Malvyne; Hamy, Antoine; Neunlist, Michel.
  • Venara A; TENS - The enteric nervous system in gut and brain disorders, INSERM U1235, 44093, Nantes, France. auvenara@yahoo.fr.
  • Duchalais E; L'UNAM, University of Angers, Angers, France. auvenara@yahoo.fr.
  • Dariel A; Department of Digestive and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France. auvenara@yahoo.fr.
  • Aubert P; TENS - The enteric nervous system in gut and brain disorders, INSERM U1235, 44093, Nantes, France.
  • Durand T; CHU Nantes, Hotel Dieu, Institut des maladies de l'Appareil Digestif, 44093, Nantes, France.
  • Meurette G; TENS - The enteric nervous system in gut and brain disorders, INSERM U1235, 44093, Nantes, France.
  • Rolli-Derkinderen M; L'UNAM, University of Nantes, Nantes, France.
  • Hamy A; TENS - The enteric nervous system in gut and brain disorders, INSERM U1235, 44093, Nantes, France.
  • Neunlist M; TENS - The enteric nervous system in gut and brain disorders, INSERM U1235, 44093, Nantes, France.
World J Surg ; 42(4): 953-964, 2018 04.
Article en En | MEDLINE | ID: mdl-28983734
ABSTRACT

BACKGROUND:

Postoperative ileus (POI) is observed in 20-30% of patients undergoing colorectal cancer surgery, despite enhanced recovery programs (ERPs). Cyclooxygenase (COX)-2 is identified as a key enzyme in POI, but other arachidonic acid pathway enzymes have received little attention despite their potential as selective targets to prevent POI. The objectives were to compare the expression of arachidonic acid metabolism (AAM) enzymes (1) between patients who underwent colorectal cancer surgery and followed an ERP or not (NERP), (2) and between ERP patients who experimented POI or not and (3) to determine the ability of antagonists of these pathways to modulate contractile activity of colonic muscle.

METHODS:

This was a translational study. Main outcome measures were gastrointestinal motility recovery data, mRNA expressions of key enzymes involved in AAM (RT-qPCR) and ex vivo motility values of the circular colon muscle. Twenty-eight prospectively included ERP patients were compared to eleven retrospectively included NERP patients that underwent colorectal cancer surgery.

RESULTS:

ERP reduced colonic mucosal COX-2, microsomal prostaglandin E synthase (mPGES1) and hematopoietic prostaglandin D synthase (HPGDS) mRNA expression. mPGES1 and HPGDS mRNA expression were significantly associated with ERP compliance (respectively, r2 = 0.25, p = 0.002 and r2 = 0.6, p < 0.001). In muscularis propria, HPGDS mRNA expression was correlated with GI motility recovery (p = 0.002). The pharmacological inhibition of mPGES1 increased spontaneous ex vivo contractile activity in circular muscle (p = 0.03).

CONCLUSION:

The effects of ERP on GI recovery are correlated with the compliance of ERP and could be mediated at least in part by mPGES1, HPGDS and COX-2. Furthermore, mPGES1 shows promise as a therapeutic target to further reduce POI duration among ERP patients.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / ARN Mensajero / Neoplasias Colorrectales / Ileus / Motilidad Gastrointestinal Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Año: 2018 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / ARN Mensajero / Neoplasias Colorrectales / Ileus / Motilidad Gastrointestinal Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Año: 2018 Tipo del documento: Article