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??Laparoscopic 180°anterior fundoplication for gastroesophageal refulx disease QIN Ming-fang??SUN Xiang-yu. Department of Mini-invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100,China Corresponding author: QIN Ming-fang, E-mail: XiangYu Sun2007@Yahoo.cn Abstract Objective To investigate the reliability and effect of laparoscopic 180°anterior fundoplication for gastroesophageal refulx disease. Methods From January 2005 to April 2008, 54 cases of gastroesophageal refulx disease were treated by laparoscopic 180°anterior fundoplication. All the cases were followed up for 3 to 25 months. Results All the cases were treated by laparoscopic 180°anterior fundoplication. Laparoscopic 180°anterior fundoplication was found to provide better control of reflux related symptom. The postoperative esophageal manmometry increased from (6.7±1.3)mmHg to (19.1±3.4)mmHg??P1??0.01?? after 6 months, to (21.6±1.8 )mmHg ??P2??0.01?? after 1 year. The DeMeester score of 24h pH monitor declined from 97.2±2.7 to 6.4±2.2 ??P1??0.01?? after 6 months, to 6.7±2.3 ??P2??0.01?? after 1 year. No postoperative complications occurred. There was no conversion to open operation and death. Conclusion Laparoscopic 180°anterior fundoplication offers the same effect as Nissen and Toupet of a high and durable level of disease control, moreover with few side effect.     

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目的 探讨理想的全胃切除术后消化道重建方式。方法 对1995－1999年经病理证实行全胃切除术胃癌235例进行回顾性分析。其中，功能性间置空肠代胃术（FJI）78例（33．2％），“P”型Roux-en-Y空肠代胃术（PR）157例（66．8％），随访2年，比较其术后的并发症、Visick指数、体重变化。结果 89％的FJI术后病人的Visick系数为Ⅰ-Ⅱ;PR的Roux-en-Y滞留综合征（RSS）发生率为42．7％。倾倒综合征、返流性食管炎分别为16．7％、26．5％。结论 FJI保持了重建消化道神经－肌肉功能的连续性，恢复食物经过十二指肠通道，对于减少全胃术的并发症、提高生存质量有重要意义，是全胃切除术后理想的消化道重建术式。     

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??Clinical study on preoperative oral carbohydrate for patients performed gastric neoplasms resection LU Zheng-hao??ZHANG Wei-han??YANG Kun??et al. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University??Chengdu 610041??China
Corresponding author??HU Jian-kun??E-mail: hujkwch@126.com
Abstract Objective To investigate the safety and efficacy of oral intake of glucose solution before surgery in patients performed resection for gastric neoplasms. Methods The clinical data of 44 patients who underwent resection for gastric neoplasms between January 2012 and May 2012 in the Department of Gastrointestinal Surgery??West China Hospital of Sichuan University were collected. The 44 patients with preoperative oral carbohydrate were assigned to group A??while the other 88 patients (group B) with fasting for 10 hours before operation were matched with those in group A with the ratio of 2??1 by gender??age and type of gastrectomy. The comparison was based on the operative and postoperative measures. Results The operation time and the blood loss did not differ between the two groups??while no regurgitation and pulmonary aspiration of gastric contents occurred in both groups. There was no significant difference in the time to pull gastric tube , catheter and abdominal drain tube??the amount of gastric tube drainage liquids, time to first flatus??time of resume fluids, incidence of operative and nonoperative complication, time of hospital stay between two groups??P>0.05??. Compared to group B??the amount of abdominal drain drainage liquids in group A was smaller??197.3±118.8 mL vs. 269.2±207.3 mL??P=0.019??. Furthermore??No hospital readmission was found in 30 days after operation in two groups. Conclusion The safety of administering preoperative oral carbohydrate fluids is supported. But the benefit of the treatment regimen for contributing to improve early rehabilitation and shorter hospital stays after elective gastric surgery is not superior to traditional preoperative preparation.     

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目的 探讨胃癌临床病理特征与淋巴结转移的关系,为临床进行合理的淋巴结清扫范围提供依据。方法 统计1200例胃癌标本,术后常规解剖原发灶及各组淋巴结,并标记和计数,计算肿瘤部位、浸润深度、Borrmann分型及分化程度与淋巴结转移率的关系。结果 胃癌的淋巴结转移率为73％,转移度为35．6％;C、M、A区及全胃癌淋巴结转移率为60．3％、55．4％、63．1％和88．4％;早期胃癌、浆膜内和浆膜外浸润的淋巴结转移率依此呈递增趋势（P＜0．05）;Borramnn Ⅲ、Ⅳ型胃癌淋巴结转移率明显高于BorrmannⅠ、Ⅱ型（P＜0．05）;分化差者明显高于分化好者（P＜0．05）。结论 术中淋巴结清扫应按胃癌的临床病理分期、部位、大小、大体分型和分化程度作出判断,并结合不同分区淋巴结分组、分站转移特点,合理选择淋巴结清扫范围。     

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??Clinical application of Sentinel lymph node biopsy technology in gastric cancer and it′s micrometastasis detection YOU Jian-Quan*??MA Li-lin .*Department of General Surgery, Taizhou People’s Hospital,Taizhou 225300, China Abstract Objective To investigate the micrometastasis of sentinel lymph node and the feasibility of sentinel lymph node biopsy in gastric cancer. Methods Sixty patients with gastric cancer intraoperatvely underwent setinel lymph node biopsy with methylene. All SLNs were studied with HE and FCM (Flow cytometry) technique,respectively. ResuLts The stained SLNs couLd be identified in 56(93.3%) of 60 patients. 49 SLNs were found to have lymph node metastases in 23 patients by HE, however, 71 SLNs were found to have lymph node metastases in 27 patients by FCM.That is to say: 22 SLNs micrometastases were detected in 13 patients. In the patients with gastric cancer of T1 and T2 groups, SLN can much more accurately predict the LNs status. Conclusion Intraoperatvely SLNB with methylene in gastric cancer is more feasible in T1 and T2 groups; FCM binding SLNB can detect lymph node micrometastasis in gastric cancer as many as possible that is feasible and prospective.     

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目的　研究细胞角蛋白 2 0 (CK2 0 )和癌胚抗原 (CEA)单抗免疫细胞化学 (ICC)染色方法在胃癌病人腹腔冲洗液脱落癌细胞检测中的临床应用价值。方法　应用CK2 0和CEA两种标志物 ,对 30例胃癌病人腹腔冲洗液细胞涂片进行免疫细胞化学染色及常规腹腔冲洗液细胞学检查 (CY) ,检测腹腔内脱落癌细胞。结果　ICC阳性检出率 (43 3%)明显高于CY (2 3 3%) (P <0 0 5 ) ;CK2 0单抗检出 13例ICC阳性病例中的 12例(92 3%) ,优于CEA(76 9%) ;腹腔内癌细胞的脱落与浆膜受侵、胃癌分化程度、有无淋巴结转移相关 (P <0 0 5 ) ,并与临床分期密切相关 (P <0 0 1)。结论　采用CK2 0单抗免疫细胞化学染色方法检测腹腔冲洗液中脱落癌细胞是一种简单有效的方法 ,有临床实用价值。     

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??Next-generation sequencing assistants in diagnosis of testicular metastatic adenocarcinoma after gastric cancer surgery CAO Yan-shuo*, SUN Li, SHEN Lin. *Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education of China), Department of GI Oncology, Peking University Cancer Hospital& Institute, Beijing 100142, China
Corresponding author: SHEN Lin, E-mail: linshenpku@163.com
Abstract Objective To investigate the role of next-generation sequencing technique in the diagnosis and treatment of cancer. Methods Using traditional pathologic diagnosis and next-generation sequencing and molecular evolutionary genetics analysis (MEGA) in a patient who was diagnosed of testicular metastatic adenocarcinoma 7 years after the radical surgery of gastric cancer. Results Pathologists make the conclusion that testicular tumor is the metastasis from gastric cancer, while the results of sequencing indicates that there may be other potential original tumor instead of gastric cancer from 7 years ago. Conclusion New gene detection technique has challenged the conclusion of traditional histopathology, and there is necessity to accumulate more data in future research to better apply this technique in clinical practice.     

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??Fast track surgery in laparoscopic gastrectomy for gastric cancer ZHAO Kun, WANG Gang, JIANG Zhi-wei, et al. Research Institute of General Surgery??Nanjing General Hospital of Nanjing Military Command PLA??Nanjing University School of Medicine, Nanjing 210002??China
Corresponding author ??JIANG Zhi-wei, E-mail??surgery34@163.com
Abstract Objective To evaluate the safety and effectiveness of fast track surgery in laparoscopic gastrectomy for gastric cancer. Methods The clinical data of 120 patients with gastric cancer performed gastrectomy between 2008 and 2011 in Nanjing General Hospital of Nanjing Military Command PLA were analyzed retrospectively. All patients received elective gastric cancer resection, and were divided into three groups?? group A (open gastrectomy, n=40) , group B (open gastrectomy with fast track surgery, n=40) and group C ( laparoscopic gastrectomy with fast track surgery, n=40). The clinical data and gut function were assessed in three groups. Results There were no significant differences in postoperative complication and the number of lymph node harvest between 3 groups. Blood loss was less in group C than group A and group B (P<0.01) , but its operative time was longer and its cost was more than other two open surgery groups (P<0.01). Recovery of bowel function in group C was faster, and postoperative hospital stay was shorter than group A (P<0.01). However, recovery of bowel function and postoperative hospital stay in group C were not different from group B (P>0.05). Conclusion Postoperative hospital stay can be shorter and recovery of bowel function can be faster in laparoscopic gastrectomy with fast track surgery plan compared with traditional care group. But when using fast track surgery plan, laparoscopic gastrectomy is not superior to open surgery.     

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胸外科范畴内的消化道恶性肿瘤 ,按常规行肿瘤切除和消化道重建后 ,上提到胸腔里的胃顺自然置于胸膜腔后壁的办法 ,已成为胸外科常采用的术式。该术式有很多不足之处。我院对此进行了改进。共实施了 2 9例手术 ,获得了满意的临床效果。现报告如下。1　临床资料1.1　一般资料本组 2 9例 ,男性 2 3例 ,女性 6例。年龄 5 476岁 ,平均46 4岁。其中贲门癌 11例 ,下段食管癌 9例 ,中段食管癌5例 ,上段食管癌 4例。全组均经手术切除 ,病理证实为恶性肿瘤。1.2　手术方法全组手术均经左侧开胸 ,按常规切除肿瘤和重建消化道。吻合口位于主动脉弓下 2 …     

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目的 研究乳腺癌乳头乳晕复合体(NAC)的浸润规律。方法 选择临床手术的女性原发乳腺癌病人86例。对可能影响NAC浸润的因素进行单、多因素分析。结果 NAC浸润率43％。NAC浸润率随肿瘤缘距乳晕边缘的距离(D)值的增加而下降，腋窝淋巴结有转移时NAC浸润率较无转移时高。肿瘤部位、临床分期、乳头异常、肿瘤大小也可影响NAC的浸润；年龄、病理类型并不影响NAC的浸润。结论 乳腺癌的NAC浸润并不少见。D值和腋窝淋巴结状态是影响NAC浸润的主要因素。     

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??Investigation of pancreatic function and quality of life of severe acute pancreatitis patients complicated with gastrointestinal fistulas ZHANG Jing-zhu, TU Jian-feng, LU Ying-ying, et al. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
Corresponding author: TONG Zhi-hui,E-mail:njzyantol@hotmail.com
Abstract Objective To study the pancreatic function and quality of life of discharged severe acute pancreatitis patients (SAP) complicated with gastrointestinal fistulas in hospital. Methods The quality of life and pancreatic function of 109 patients were collected from March 2016 to November 2016, which included 29 patients with and 80 patients without gastrointestinal fistulas. Pancreatic endocrine test included blood glucose, fasting insulin, fasting C-peptide, fasting glucagon??oral glucose tolerance test (OGTT) 2 hours blood glucose,2 hours insulin,2 hours C-peptide,2 hours glucagon, and fecal elastase (FE-1) were used to assess the patients pancreatic exocrine function. The patient's quality of life questionnaire (SF-36) and clinical data in hospital were collected. Pancreatic function and quality of life in patients of the two groups were compared. Results Compared with the cases without gastrointestinal fistulas ,more cases of SAP patients with gastrointestinal fistulas were required surgical interventions [19(65.6%) cases vs.19 (23.8%) cases, χ2=0.96, P=0.000], and got significant weight reduction during hospitalization [(8.7±0.6) kg vs.(6.8±0.5) kg, t=2.240,P=0.027], and had lower discharged quality of life [(119.3±2.8) score vs.(128.1±1.1) score, t=3.57,P=0.006]. But there was no significant difference in pancreatic function between the two groups in fasting blood glucose [(6.9±0.5)mol/L vs. (6.3±0.3)mol/L],fasting insulin[(9.5±2.4)mU/L vs. (7.9±0.7)mU/L], fasting C-peptide[(0.7±
0.3)nmol/L vs. (0.5±0.3)nmol/L],fasting glucagon[(37.8±3.7)pmol/L vs.(40.0±2.6)pmol/L]?? OGTT 2hours blood glucose[(11.9±1.3)mol/L vs.(10.1±0.7)mol/L],2 hours insulin [(36.7±7.0)mU/L vs.(35.9±3.5)mU/L],2 hours C-peptide [(1.6±1.2)nmol/L vs.( 1.5±1.0) nmol/L],2 hours glucagon[(43.0±3.4)pmol/L vs.(41.5±2.4) pmol/L]. Conclusion SAP patients with gastrointestinal fistula have lower quality of life than those without gastrointestinal fistula. However, there is no significant differences in pancreatic function between the two groups.     

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??Comparative study on the conventional dissection and curettage-aspiration dissection in lymph node dissection for advanced gastrointestinal cancer CHEN Xiao-peng*, ZHANG Guo-zheng, LI Shu-ren, et al. *Department of General Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241001,China Corresponding author: CHEN Xiao-peng??E-mail??drcxp@sohu.com Abstract Objective To compare the effectiveness of the conventional dissection and curettage-aspiration dissection in lymph node dissection for advanced gastrointestinal cancer. Methods Ninety-seven patients with advanced gastrointestinal cancer admitted between January 2004 and August 2007 at Yijishan Hospital of Wannan Medical College were randomly divided into the conventional surgery group (CS group) and the curettage-aspiration surgery group (CA group). The operation time, intraoperative hemorrhage quantity, blood transfusion amount, the number of cleared lymph node and postoperative data of follow-up were collected. Results The average surgery time was 203.62 mins in CS group and 209.60 mins in CA group??respectively. The intraoperative hemorrhage quantity was 330.64 and 245.00 mL with the blood transfusion amount 683.33 and 504.50 mL, respectively. The average number of cleared lymph node was 11.60 and 17.48, respectively. The follow-up time was 17??60 months, with an average of 36 months. The tumor recurrence rates in CS group and CA group were 48.72% (19/39) and 26.83% (11/41), respectively, and 3-year survival rates were 56.41% and 75.61%, respectively. Conclusion Curettage-aspiration dissection may improve the extent and effectiveness of lymph node dissection for advanced gastrointestinal cancer, reduce the hemorrhage quantity, decrease the tumor recurrence rate and lengthen the live time of patients.     

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目的 研究胃癌瘤体中血管细胞粘附分子（VCAM－1）对胃癌的血管生成、生长、转移的影响。方法 对30例胃癌、8例胃溃疡,10例正常人标本进行了免疫组化染色、图像分析,分析瘤体VCAM－1的表达与胃癌病理参数的关系。结果 VCAM－1不仅表现在胃癌血管内皮细胞上高表达,在胃癌细胞膜上也有表达,而且VCAM－1的表达强度表达率与胃癌的血管的生成和转移有关。结论 VCAM－1在胃癌的血管生成、瘤细胞转移中可能起到重要作用,其促进了胃癌肿瘤血管的形成。     

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??Role of endoscopic ultrasound in the staging of gastric stump carcinoma WU Qi*??LI Zi-yu??BU Zhao-de,et al. * Endoscopy Center??Institute of Clinical Oncology, Peking University School of Oncology, Beijing100142, China Corresponding author??ZHANG Ji-chang, E-mail??drzhangjichang@sina.com Abstract Objective To investigate the accuracity of endoscopic ultrasound (EUS) for staging the gastric stump carcinoma (GSC). Methods Twenty-one consecutive patients with pathological proved GSC were checked with endoscopic ultrasound between October 2001 and March 2009 at Peking University School of Oncology. All patients subsequently underwent remnant total gastric resection with lymph node dissection. The pathological staging with EUS staging was compared. Results Overall T2,T3,T4,N0,N1,N2,and N3 of EUS staging for GSC in the group were3,9,9,3,6,6 and 6 cases, respectively. On the contrast??T2,T3,T4,N0,N1,N2, and N3 of pathological staging in the group were3,13,5,3??4,4 and 10 cases, respectively. Diagnostic accuracy of EUS for GSC TN stage in the group were 81.0% and 76.2%. Conclusion EUS is a non-invasive technique with high accuracy for TN staging in the GSC patients. However, due to the low specificity with metastasis lymph nodes, it is suggested to ally with CT .     

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??Evaluation of PA-MSHA vaccine on the prophylaxis of post-operative intraperitoneal recurrence and metastasis in advanced gastric cancer LING Wei, LIU Hua, CAO Hui, et al. Department of General Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China Corresponding author ??LIU Hua , E-mail: housman111@yahoo.com.cn Abstract Objective To evaluate the killing effect by PA-MSHA vaccine on gastric cancer cells in vitro and its effect on the prophylaxis of post-operative intraperitoneal recurrence and metastasis in advanced gastric cancer. Methods MTT method was used to observe the inhibition and killing effect by PA-MSHA vaccine on gastric cancer cell strain MKN45 between January 2005 and December 2007 at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Specific combination and inhibition of cell proliferation were observed by transmission electron microscopy. Sixty cases of advanced gastric cancer T3M0 were selected into the study which were randomly separated into two groups: PA-MSHA group and control group. It observed side effects, effect on the patients’immune function and intraperitoneal recurrence or metastasis. Results PA-MSHA vaccine could specifically combine and penetrate into the gastric cancer cell strain MKN45 so as to inhibit its proliferation and the killing effect was in direct proportion to its dose. The side effect of PA-MSHA vaccine was comparatively limited. In PA-MSHA group, the cellular immune function was strengthened and intraperitoneal recurrence or metastasis decreased significantly. Conclusion PA-MSHA vaccine has dose-dependent killing effect on gastric cancer cell strain MKN45 by specific combination. It is safe and feasible which can strengthen the cellular immune function and reduce intraperitoneal recurrence or metastasis in advanced gastric cancer.     

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??Usage of mechanical stapler in digestive tract reconstruction of laparoscopic total gastrectomy MIAO Ru-lin??LI Zi-yu??WANG Yin-kui??et al. Gastrointestinal Cancer Center, Peking University Cancer Hospital &Institute; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
Corresponding author??LI Zi-yu?? E-mail??ligregory@outlook.com
Abstract Objective To evaluate the safety and effectiveness of mechanical staplers in laparoscopic total gastrectomy. Methods The clinical data of gastric adenocarcinoma patients who received laparoscopic-assisted or totally laparoscopic total gastrectomy in Gastrointestinal Cancer Center Ward I of Peking University Cancer Hospital from March 2012 to April 2016 was collected retrospectively. The clinical pathologic characteristics??operative features and postoperative recovery features were compared between patients with linear stapler (LS) and the ones with circular stapler (CS). Logistic regression was used to identify the risk factors of postoperative complications. Results A total of 72 patients were enrolled in the study with 47 patients in the CS group and 25 patients in the LS group. The difference of age??gender??BMI??tumor size??Lauren classification??differentiation grade??and pathologic stage between the two groups were not significant statistically??P??0.05??. The proportion of patients who received preoperative therapy were lower in the LS group (4.0% vs.27.7%??P=0.026). The difference of surgical time and intraoperative blood loss of OS group and LS group were not significant statistically (median surgical time??247min vs. 258min??median intraoperative blood loss??100mL vs. 50mL). There was no statistical difference in the extent of curative??retrieved lymph node number??and proximal margin distance between the two groups. On postoperative recovery??the first liquid diet time was shorter in the LS group (3.5d vs. 5.0d??P=0.030)??but the postoperative hospital stay??first flatus time??first semi-liquid diet time and first abdominal drainage tube removing time were same statistically between the two groups. The rates of postoperative complications were 25.5% and 32.0% in CS group and LS group (P =0.560)??and no risk factor was identified in regression model. Conclusion For laparoscopic total gastrectomy??mechanical staplers are safe. The surgical time??intraoperative blood loss and postoperative risk of linear stapler are comparable to those of circular stapler??and gastrointestinal function recovery may be faster in linear stapler group.     

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自 1990年 11月至 1995年 5月 ,我们对行肝癌根治性切除术的 85例病人 ,于术中同时行肝动脉门静脉双埋泵(ＩＤＤＳ) ,用以术后化疗与栓塞 ,取得了良好的疗效。现对照同期未行埋泵术的 2 9例肝癌手术病人 ,报告如下。1　临床资料治疗组 85例 ,男 76例 ,女 9例。年龄平均 49岁 ( 2 4～73岁 )。全部病例均为肝细胞癌。单发肿瘤 75例 ,肿瘤位于肝脏某一段或有数段同时累及。多发肿瘤 ( 2处病灶 ) 10例 ,肿瘤分别位于左右肝或不相邻的两个肝段。肿瘤大小1 8～ 2 7ｃｍ不等。对照组 2 9例 ,男 2 5例 ,女 4例。年龄平均 45岁 ( 2 2～ 6 9岁 )。肿瘤…     

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全胃切除是胃体癌和累及两个分区以上胃癌的首选术式 ,其手术并发症和术后生存质量与消化道的重建方式有关。自 1995年 10月至 1997年 6月 ,我院为 30例胃癌病人施行根治性全胃切除 ,原位十二指肠、部分空肠翻转代胃消化道重建手术 ,获得满意效果 ,报告如下。1　资料与方法1 1　一般资料30例病人中 ,男 18例 ,女 12例。年龄 2 7～ 72岁 ,中位年龄 5 2岁。肿瘤部位 :ＭＡＣ/ＭＣＡ 1例 ,ＭＣ/ＣＭ 5例 ,ＭＡ/ＡＭ 9例 ,Ｍ 13例 ,胃窦及胃体双原发癌 1例 ,残胃癌1例。组织学类型及分级 :30例中 ,高、中、低分化腺癌分别为 5、8、9例 ,粘液腺癌…     

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??Evaluation of glutamine-enhanced enteral nutritional support by gastro-duodenal route in the patients after total gastrectomy LIU Hua, LING Wei, SHEN Zhi-yong, et al. Department of General Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Corresponding author??CAO Hui, E-mail: housman111@yahoo.com.cn
Abstract Objective To evaluate glutamine-enhanced enteral nutritional support by gastro-duodenal route in the patients after total gastrectomy. Methods From October 2006 to February 2009, 72 patients receiving total gastrectomy at Department of General Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected. They were randomly divided into 3 groups: glutamine-enhanced enteral nutrition (EN+Gln) group, enteral nutrition (EN) group and the control group. The patients received nutrition support within 48 h after operation for 7 days. The occurance of postoperative complication and hospitalization duration were compared. Besides serum total protein, albumin, proalbumin and transferrin were measured 1 day before operation, the 3rd day and the 12th day after operation. And on the 7th day after operation, NK cells, CD4+T and CD8+T cells, IgM and IgG levels in peripheral blood were measured. Results The occurrence of postoperative complication and hospitalization duration in the EN+Gln and EN group were fewer than those in the control group. The postoperative serum level of total protein, albumin, proalbumin and transferrin on the 3rd day after operation of all groups decreased significantly(P<0.05) while those data of EN+Gln and EN group on the 14th day after operation were significantly higher than those of the control group. On the 7th day after operation NK cells, CD4+T cells, IgM and IgG levels of the EN+Gln group increased prominently and significantly higher than those of EN and the control group. Conclusion For the patients receiving total gastrectomy, perioperative glutamine-enhanced nutritional support can improve nutrition and immune status and reduce the incidence of postoperative complication and hospital stay.