Impact Of A Fast-track Surgery Programme For Laparoscopic Radical Hysterectomy

Objective To investigate the effect of fast track surgery on clinical outcome and immune function after laparoscopic radical hysterectomy in patients with cervical cancer. Methods 86 patients undergoing laparoscopic radical hysterectomy and pelvic lymphadenectomy were randomly divided into two groups:fast track surgery(FTS)group and control group.The operation time,anesthesia time,bleeding volume,length of stay, evacuating time,the incidence of nausea or vomiting,CRP,IL-6,Ig A,Ig G,Ig M,CD3+,CD4+, CD4+/CD8+ were compared before operation and the 1st day and 3rd day after operation.Result There were no significant differences in operation time, anesthesia time, bleeding volume and the incidence of nausea or vomiting. Length of stay and evacuating time were lower in FTS group than in control group.There were no significant differences in all the parameters between two groups before operation. CRP was 21.69±8.97mg/L in FTS group,and 29.08±8.56mg/L in control group。There was significant difference between the two groups(P<0.05). In the1st and 3rd day after operation, IL-6 in FTS group was5.76±1.88ng/L、4.34±1.96ng/L respectively,and 7.65±2.89ng/L、6.76±2.73ng/L in control group.There was significant difference between the two groups(P<0.05). In the 1st and 3rd day after operation, Ig M in FTS group was 1.46±0.62g/L, 1.47±0.57g/L respectively,and 0.91±0.38 g/L,1.05±0.47g/L in control group.There was significant difference between the two groups(P<0.05). There were no significant differences in Ig A and Ig G between two groups after operation. In the 1st day after operation,CD3~+T cell,CD4~+T cell and CD4~+/CD8~+in FTS group was 56.62±8.79%、26.13±4.67% and 1.24±0.22 respectively,and 50.08±8.65%、23.95±2.67% and 0.90±0.27 in control group.There was significant difference between the two groups(P<0.05). In the3 rd day after operation, CD4~+T cell and CD4~+/CD8~+in FTS group was27.31±4.56%、1.30±0.21 respectively,and 24.37±3.95%、1.07±0.19 in control group.There was significant difference between the two groups(P<0.05),but there was no significant difference in CD3~+T cell between the two group. One patient of FTS group had a fever after the removal of drainage tube. Conclusions Fast track surgery maybe accelerate the recovery of gastrointestinal function, reduce the stay time on hospital,mitigate the immunologic impairment of cervical cancer patients after laparoscopic radical hysterectomy and pelvic lymphadenectomy,and accelerates postoperative rehabilitation.