Effects of structured triglyceride and medium and long chain triglyceride on postoperative efficacies of elderly patients (≥70 years old) after total gastrectomy for gastric cancer

Objective To investigate the effects of structured triglyceride and long chain triglyceride/medium chain triglyceride (LCT/MCT) on postoperative efficacies of elderly patients (≥70 years old) after total gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinical data of 42 elderly patients who underwent total gastrectomy for gastric cancer in the Jiangsu Cancer Hospital between Sepember 2014 and September 2015 were collected. Twenty-two patients using structured triglyceride in postoperative parenteral nutrition and 20 using LCT/MCT in postoperative parenteral nutrition were allocated into the case and control groups, respectively. All the patients underwent total gastrectomy+ Roux-en-Y esophago-jejunostomy. Patients in the case and control groups received respectively 20% structured triglyceride and 20% LCT/MCT. Observation indicators: (1) postoperative recovery situation: time of gut exsufflation, changes of body mass at postoperative 5 days, postoperative anastomotic leakage and abdominal infection; (2) test of liver function indexes: aspartate transaminase (AST), alanine transaminase (ALT), total bilirubin (TBil), direct bilirubin (DBil) of liver function in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5; (3) test of nutritional indexes: serum total protein (TP), albumin (Alb) and prealbumin in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5; (4) test of immunological indexes: levels of IgG and IgA, CD3, CD4 and ratios of CD3/CD8 in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5. Measurement data with normal distribution were represented as ±s. Repeated measures data were evaluated with the repeated measures ANOVA. Count data were analyzed using the chi-square test and Fisher exact probability. Results (1) Postoperative recovery situation: there was no special adverse reaction during support treatment of parenteral nutrition. Time of gut exsufflation, changes of body mass at postoperative 5 days, incidences of postoperative anastomotic leakage and abdominal infection were (46±12)hours, (60±8)kg, 0, 0 in the case group and (50±14)hours, (58±9)kg, 0, 1 in the control group, respectively, with no statistically significant difference between the 2 groups (t=0.86, 0.65, P>0.05). (2) Test of liver function indexes: levels of AST and ALT from preoperation to postoperative day 5 were respectively from (24±9)U/L to (22±6)U/L, from (31±12)U/L to (20±8)U/L in the case group and from (23±8)U/L to (30±10)U/L, from (30±9)U/L to (32±7)U/L in the control group, respectively, with statistically significant differences between the 2 groups (F=92.87, 87.92, P 0.05). (3) Test of nutritional indexes: levels of serum TP and Alb from postoperative day 1 to postoperative day 5 were respectively from (52±6)g/L to (56±5)g/L, from (34±3)g/L to (37±4)g/L in the case group and from (53±7)g/L to (52±4)g/L, from (33±3)g/L to (31±3)g/L in the control group, respectively, with no statistically significant difference in changing trends between the 2 groups (F=0.47, 0.54, P>0.05). Levels of prealbumin from postoperative day 1 to postoperative day 5 were respectively from (230±32)mg/L to (245±30)mg/L in the case group and from (228±28)mg/L to (222±26)mg/L in the control group, respectively, with a statistically significant difference in changing trend between the 2 groups (F=16.81, P<0.05). (4) Test of immunological indexes: levels of IgG and IgA, CD3, CD4 and ratios of CD4/CD8 from postoperative day 1 to postoperative day 5 were respectively from (12±4)g/L, (2.20±0.20)g/L, 52%±4%, 30%±4%, 1.30±0.20 to (18±5)g/L, (2.80±0.30)g/L, 59%±4%, 33%±4%, 1.50±0.20 in the case group and from (12±3)g/L, (2.10±0.10)g/L, 52%±4%, 27%±4%, 1.30±0.10 to (13±4)g/L, (2.30±0.20)g/L, 51%±4%, 26%±4%, 1.20±0.20 in the control group, respectively, with statistically significant differences in changing trends between the 2 groups (F=25.07, 29.42, 33.53, 22.19, 33.47, P<0.05). Conclusions The short-term usage of structured triglyceride or LCT/MCT in early period after operation can effectively improve postoperative recovery of elderly patients with gastric cancer, with a small impact on liver function. Structured triglyceride can improve immunologic function and nutrition status more effectively. Key words: Gastric neoplasms; Elderly; Structured triglyceride; Medium-chain triglyceride/long-chain triglyceride; Perioperative period