The Application Of Enhanced Reovery After Surgery Combined With Laparoscopy-assisted Radical Gastrectomy For Gastric Cancer

Objective: To study the safety and feasibility of the enhanced recovery after surgery(ERAS)propram in laparoscopy-assisted radical gastrectomy for gastric cancer.To observe the postoperative recovery,complication morbidity,analgesic effect,nutritional status and stress response in patients with ERAS protocol.To explore a more reasonable ERAS protocol.Methods: The clinical data of surgical treatment on patients in the Second Hospital of Dalian Medical University from January 2014 to January 2016 received laparoscopy-assisted radical gastrectomy were retrospectively analyzed.The operation of the two groups were performed by the same group of surgeons.According to reconstruction methods,and selected by Gmatch method basing on gender,age,and tumor staging,all patients were divided into ERAS group and conventional group.The data of clinical index(operation time,blood loss,the first flatus time,first defecation time,length of hospital stay and cost of hospitalization),complications(pneumonia,wound infection,urinary infection,abdominal infection,gastric retention,anastomotic leak,deep-vein thrombosis,intestinal obstruction,reoperation,readmission and mortality),pain index(VAS score),nutritional index(albumin,prealbumin)and stress index(C-reactive protein and interleukin-6)were compared among the two groups.RESULTS: Compared with the conventional group,ERAS shortened the duration of flatus(62.88 ± 16.48 h vs 73.57 ± 19.22 h,P=0.003)and duration of defecation(69.98±18.55 h vs 89.00±21.22 h,P=0.000),reduced the cost of hospitalization(31547.25±6547.16 RMB vs 39782.72±8332.51 RMB,P=0.000)and duration of postoperative stay(8.08±1.70 d vs 9.43±1.69 d,P=0.000).There was no significant difference in operation time(226.33±47.96 vs 234.59±43.35,P=0.364)and blood loss(78.69±26.89 vs 82.67±30.36,P=0.485)between the two groups(P>0.05).The total number of complications in ERAS group was significantly lower than that in the conventional group(P<0.05),but there was no significant difference in each complication of two groups(P>0.05).The VAS score of postoperative day(POD)1 to POD5 was recorded to evaluate the postoperative analgesic effect of the two groups.Although the two groups used different methods of postoperative analgesia,there was no significant difference in analgesic effect between the two groups(P>0.05).The postoperative serum albumin and prealbumin were decreased in each group,which were lowest on POD1,then gradually increased.Serum albumin and prealbumin were no significant difference in two groups on POD1 and POD3(P>0.05),but increased significantly in ERAS group on POD7(P<0.05).C-reactive protein and interleukin-6 level of twe groups were found to gradually increased after operation,which were highest on POD3,then gradually decreased.C-reactive protein levels were lower in the ERAS group on POD3 and POD5(P<0.05).Interleukin-6 levels were lower in the ERAS group on 1,3 and 5 days postoperatively(P<0.05).CONCLUSION: The combination of ERAS protocol and laparoscopy-assisted radical gastrectomy for gastric cancer is safe and feasible.It can promote the recovery of postoperative gastrointestinal function,shorten the hospitalization time and reduce the cost of hospitalization.What is more,during the perioperative period,it can improve the nutritional status,reduce the stress response and enhance the recovery of patients.