Scholarlink

Background <p>Patients undergoing abdominoperineal or intersphincteric resection for low rectal cancer experience profound physiological and psychological stress. Conventional Enhanced Recovery After Surgery (ERAS) protocols mainly address surgical and metabolic factors but rarely target the host’s psychosocial and immunometabolic recovery.</p> Study design <p>In this single-center randomized controlled trial, 240 patients with stage II–III low rectal cancer (September 2019–September 2021) were randomized (1:1) to receive either standard ERAS care or an integrated perioperative intervention combining resilience-based psychosocial support, cognitive behavioral therapy for insomnia, and Prognostic Immune Nutritional Index (PINI)-guided nutritional optimization. The primary outcomes were global quality of life (EORTC QLQ-C30) and sleep quality (Pittsburgh Sleep Quality Index). The secondary outcomes included postoperative recovery, inflammatory and nutritional indices, and 3-year disease-free and overall survival.</p> Results <p>At 12&#xa0;months, the intervention group showed greater improvement in quality of life (mean difference = 12.3, 95% CI 8.6–16.0; <i>p</i> &lt; 0.001) and sleep quality (–3.1, 95% CI –4.5 to –1.8; <i>p</i> &lt; 0.001). Serum interleukin-6 declined more rapidly (–1.9&#xa0;pg/mL vs –0.8; <i>p</i> &lt; 0.001), accompanied by improved PINI (–0.7; <i>p</i> &lt; 0.01) and higher fecal short-chain fatty acid levels (+ 10.6&#xa0;mmol/kg; <i>p</i> &lt; 0.001). Three-year disease-free survival favored the intervention (HR 0.69, 95% CI 0.51–0.93; <i>p</i> = 0.015). No intervention-related serious adverse events occurred.</p> Conclusions <p>Integrating psychosocial, sleep, and immunonutritional components into perioperative care enhanced functional and physiological recovery after low rectal cancer surgery. These findings support extending ERAS toward targeted modulation of host response to improve both short- and long-term outcomes.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Integrated psychosocial, sleep, and immunonutritional intervention improves psychological adaptation, sleep disturbance, and inflammatory activation in rectal cancer: a randomized controlled trial

  • 期刊论文

  • 发表日期：

    2026年2月19日

查看全文
  • Shengjie Pan,
  • Gang Wang

摘要

Background

Patients undergoing abdominoperineal or intersphincteric resection for low rectal cancer experience profound physiological and psychological stress. Conventional Enhanced Recovery After Surgery (ERAS) protocols mainly address surgical and metabolic factors but rarely target the host’s psychosocial and immunometabolic recovery.

Study design

In this single-center randomized controlled trial, 240 patients with stage II–III low rectal cancer (September 2019–September 2021) were randomized (1:1) to receive either standard ERAS care or an integrated perioperative intervention combining resilience-based psychosocial support, cognitive behavioral therapy for insomnia, and Prognostic Immune Nutritional Index (PINI)-guided nutritional optimization. The primary outcomes were global quality of life (EORTC QLQ-C30) and sleep quality (Pittsburgh Sleep Quality Index). The secondary outcomes included postoperative recovery, inflammatory and nutritional indices, and 3-year disease-free and overall survival.

Results

At 12 months, the intervention group showed greater improvement in quality of life (mean difference = 12.3, 95% CI 8.6–16.0; p < 0.001) and sleep quality (–3.1, 95% CI –4.5 to –1.8; p < 0.001). Serum interleukin-6 declined more rapidly (–1.9 pg/mL vs –0.8; p < 0.001), accompanied by improved PINI (–0.7; p < 0.01) and higher fecal short-chain fatty acid levels (+ 10.6 mmol/kg; p < 0.001). Three-year disease-free survival favored the intervention (HR 0.69, 95% CI 0.51–0.93; p = 0.015). No intervention-related serious adverse events occurred.

Conclusions

Integrating psychosocial, sleep, and immunonutritional components into perioperative care enhanced functional and physiological recovery after low rectal cancer surgery. These findings support extending ERAS toward targeted modulation of host response to improve both short- and long-term outcomes.