Resposta metabólica e inflamatória em pacientes operados por câncer de mama com ou sem uso do protocolo multimodal acerto : estudo randomizado

Abstract

To investigate the metabolic and inflammatory response in patients submitted to breast cancer surgery receiving either traditional or a multimodal protocol of perioperative care (Acerto protocol). Methods: A prospective study including 18 patients submitted to breast cancer surgical procedures and randomized to receive two types of perioperative care: 1) a drink containing 12% maltodextrine 6h (400 ml) and 2h (200 ml) before anesthesia, no postoperative intravenous hydration, refeeding up to 12h after surgery (Acerto group, n=9) or 2) 6-8h preoperative fasting, intravenous hydration during immediate postoperative period, and refeeding on PO day 1 (Control group, n=9). Blood samples were collected at anesthetic induction, and at 10h and 24h postoperatively for glucose, insulin, albumin, C-reactive protein (PCR) assays. The insulin sensitivity was assessed by Quicki equation and the inflammatory index by the PCR/albumin ratio. Data were compared by repeated measures ANOVA. Results: We found a significant increase of serum glucose (p<0.001), insulin ((p=0.002), and a reduction of insulin sensitivity (p=0.007) in the two groups without difference between them. At induction of anesthesia PCR levels (4.1±1.9 vs. 2.6±1.3 mg/L; p=0,049) and the inflammatory index (p=0,046) were significant lesser in the Acerto group. During evolution there was a significant fall of serum albumin only in control group (from 4.1±0.3 to 3.7±0.3 g/dl; p<0.05). Albumin values were significantly lesser in controls than in the Acerto patients (p=0.023) during the postoperative phase. Conclusion: The use of the Acerto multimodal protocol of perioperative care do not modify the metabolic response but reduces the acute phase inflammatory response in breast cancer surgery.