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An investigation into the impact of nutritional status on immune response and recovery in patients undergoing resective surgery for gastrointestinal surgery

Suzanne Doyle, PhD Student
Suzanne Doyle, PhD Student

Obesity is associated with the pathogenesis of several cancer types, including oesophageal and colorectal cancer. The increased cancer incidence in obese individuals is believed to be associated with the presence of excess visceral, or centrally located, fat. Visceral adipose tissue is metabolically active and secretes a number of biological compounds that alter the function of the immune system and can influence tumour initiation and progression. Visceral obesity also gives rise to a state of abnormal lipid metabolism, insulin resistance and inflammation, collectively referred to as the metabolic syndrome.

Patients receiving curative treatment of gastrointestinal cancer undergo major resective surgery and may have additional chemoradiotherapy. This treatment places a great metabolic stress on the patient and is associated with considerable morbidity and mortality. The way in which the immune system responds to this treatment influences the occurrence of complications postoperatively, such as respiratory distress or sepsis, and subsequently impacts the rate of recovery and length of hospital stay.

This project aims to determine if there is a difference in how the immune system of obese patients reacts to treatment compared those who are not obese? And whether obesity increases the likelihood of complications and lengthen hospital stay? In order to investigate this:

  1. A full nutritional and anthropometrical assessment, including quantification of visceral fat area, is carried out on patients before and after chemoradiotherapy and surgery.
  2. Patients are also screened for the presence of the metabolic syndrome, a pro-inflammatory, pro-thrombotic state associated with excess visceral fat.
  3. Blood samples are obtained at baseline and at days 1, 3, 7 and 14 postoperatively and the individual immune cell types, including natural killer cells, macrophages and neutrophils are isolated. The amount and activity of the different cell types, i.e., what pro- or anti-inflammatory compounds are being secreted, is then assessed to determine the extent of the inflammatory response.
  4. Patients’ vital signs are recorded post surgery and any complications that occur are documented.
  5. Data will then be correlated with obesity, visceral adiposity and metabolic syndrome status to examine differences in innate immune responses and the occurrence of complications in obese versus non-obese patients.

On completion of this project, it is anticipated that our knowledge of how visceral obesity and the metabolic syndrome influence the innate inflammatory immune response post surgery and risk of postoperative complications will be greatly enhanced, possibly leading to the development of new therapies to reduce the high rates of morbidity and mortality associated with surgery for gastrointestinal cancers.

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Last updated 23 November 2016 Surgery - Web Administrator (Email).