| Research purpose:To investigate the effectiveness and safety of ERAS in patients with gastric cancer combined with type 2 diabetes by observing the effects of enhanced recovery after surgery(ERAS)technique on postoperative blood glucose as well as inflammatory response,so as to promote and justify the application of ERAS technique in patients with gastric cancer combined with type 2 diabetes.Research methods:The study was conducted on patients who underwent laparoscopic radical gastric cancer surgery with combined type 2 diabetes mellitus at the Affiliated Hospital of Jiangsu University from December 2020 to December 2022.After the study was reviewed by the hospital ethics committee and clinical trial registration was completed(registration number:Chi CTR2000034236),patients were divided into a trial group(ERAS group)and a control group(conventional group)according to the different modes of perioperative management.A total of69 patients were included in this study,including 32 in the ERAS group and 37 in the control group.General data such as age,gender,BMI,duration of diabetes,glucose-lowering measures,Hb A1 c,duration of surgery,intraoperative bleeding,number of lymph nodes cleared and tumour stage were collected from the patients.The perioperative blood glucose levels(fasting blood glucose,intraoperative blood glucose,maximum fluctuation of blood glucose),related hormone levels(glucocorticoids,C-peptide,insulin,glucagon),inflammatory indexes(C-reactive protein,white blood cell count,neutrophil count),inflammatory factors(IL-4,IL-6,IL-8,IL-10,TNF-α),nutritional indexes(albumin,pre-albumin,haemoglobin,lymphocyte count),post-operative recovery(time to removal of catheter,nasogastric tube,drainage tube,time to first discharge,post-operative complications,number of days in hospital post-operatively,hospital costs).Research results:There were no significant differences between the two groups in terms of mean age,male/female ratio,BMI,surgical risk class,nutritional risk score(2002),duration of diabetes,mode of diabetes treatment,preoperative Hb A1 c,intraoperative bleeding,length of surgery and tumour stage(p>0.05),allowing for a follow-up comparison.A comparison of the perioperative fasting blood glucose between the two groups showed no significant difference between the two groups two days before surgery and in the morning of the day of surgery(p>0.05),with a gradual increase in blood glucose over time during surgery.The most significant difference in blood glucose between the two groups was found 1 h after the start of surgery(p<0.05).Postoperative fasting blood glucose levels in both groups showed a tendency to rise and then fall,with the peak occurring on the first postoperative day.Fasting blood glucose was significantly lower in the ERAS group than in the control group at postoperative days 4,5,6and 7.Further analysis of the single-day maximum blood glucose difference at 7 days postoperatively revealed that the maximum postoperative glucose fluctuation amplitude(LAGE)in patients with gastric cancer combined with diabetes increased significantly compared to the preoperative period and reached its maximum at day 1 postoperatively.The LAGE in the ERAS group was significantly smaller than that in the control group at postoperative days 5,6 and 7,and the difference was statistically significant(p<0.05).Cortisol,C-peptide,fasting insulin and glucagon levels were not significantly different between the two groups before surgery(p>0.05),and all showed a tendency to increase and then decrease after surgery.cortisol levels in the ERAS group were significantly lower than those in the control group on postoperative days 1,3 and 5,and the difference was statistically significant(p<0.05).There was a significant difference between the ERAS group and the control group only at postoperative day 3(p<0.05)and insulin levels were significantly lower than the control group at postoperative days 3 and 5(p<0.05).postoperative glucagon changes were smaller in the ERAS group and were significantly different from the control group only at postoperative day 1(p<0.05).There was no significant difference between the two groups in terms of preoperative inflammatory parameters(p>0.05).The postoperative inflammatory indexes reached a peak on postoperative day 1 and then tended to decrease gradually.the CRP level decreased more rapidly in the ERAS group and differed significantly from the control group on postoperative day 7(p<0.05).the white blood cell count in the ERAS group was significantly lower than that of the control group on postoperative days 1,3 and 5(p<0.05),and the neutrophils were significantly lower than those of the control group on postoperative days 5 and 7(p<0.05).The peak levels of postoperative inflammatory factors in the ERAS group were lower than those in the control group.IL-4 and IL-10 decreased more slowly and were significantly different from the control group at postoperative days 5 and 7 and postoperative day 7 respectively(p<0.05).IL-6,IL-8 and TNF-α levels in the ERAS group were lower than those in the control group at all time points,with IL-6 and IL-8 at postoperative days 3,5 and 7 IL-6 and IL-8 were significantly lower than the control group at postoperative days 3,5 and 7(p<0.05),and TNF-αwas significantly lower than the control group at postoperative days 1,3 and 5(p<0.05).Albumin levels were significantly higher in the ERAS group than in the control group on postoperative days 3,5 and 7,pre-albumin and lymphocytes on postoperative days 5 and 7,and haemoglobin on postoperative days 3 and 5(p<0.05).In the ERAS group,the time to first postoperative evacuation,the time to drainage tube removal,the time to catheter retention and the length of postoperative hospital stay were all significantly shorter(p<0.05).There was no significant difference between the two groups in terms of post-operative nasogastric tube retention time,complication rate and total hospital cost(p>0.05).Conclusion:Compared with traditional surgery,ERAS technique can effectively reduce postoperative stress glucose elevation in patients with gastric cancer combined with type 2 diabetes and promote blood glucose stabilization;reduce inflammatory stress,accelerate the metabolism of pro-inflammatory factors and increase the level of anti-inflammatory factors;improve nutritional status;promote intestinal function recovery;and shorten hospitalization time.The application of ERAS technique in patients with gastric cancer combined with type 2diabetes is safe and effective,and can facilitate the post-operative recovery of patients with gastric cancer combined with type 2 diabetes,which is worth promoting. |
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