The Application Of Fast Track Surgery Combined With Laparoscopic D2 Radical Operation For Gastric Carcinoma

BACKGRAND: Fast track surgery(FTS)is a series of perioperative measures for example preoperative education,thermal insulation,early oral diet and early mobilization.The aim of fast track surgery is reducing postoperative physical and psychological stresses,reducing postoperative complications,and enhance the recovery of surgery.Because of the developing of evidence-based medicine(EBM)and “socialpsychological-biological” comprehensive medicine model,fast track surgery was accepted and used by clinician.Fast track surgery has been used in colorectal surgery,breast surgery,hepatological surgery and urinary surgery successfully in Europe and America.But in China,fast track surgery is not widely used in clinic.There is no unified guideline about fast track surgery,so the clinicians' acknowledge about FTS are scarce.These the reasons why fast track surgery is not widely used.So we need more clinic trial to verify the safety of fast track surgery.Laparoscopic surgery is a minimally invasive surgery.The incidence of intestinal adhesion and infection of incisional wound of laparoscopic surgery is less than laparotomy.The recovery after surgery of laparoscopic surgery is faster than laparotomy.The minimally invasive idea is correspond to fast track surgery.Laparoscopic surgery is widely used in gastrointestinal surgery,and D2 radical operation for gastric carcinoma is the standard operation for gastric carcinoma.Some research verified that resection range and lymph node dissection range of laparoscopic surgery is similar to laparotomy.Recently,laparoscopic D2 radical operation for gastric carcinoma is popular in gastrointestinal surgery.Fast track surgery has been successfully engaged in laparoscopic colorectal cancer operation,but the research of FTS in gastric carcinoma is still less.So we are going to evaluated the safety and efficacy of fast track surgery management in gastric cancer with laparoscopy D2 gastrectomy.OBJECTIVE:To evaluated the safety and efficacy of fast track surgery(FTS)management in gastric cancer with laparoscopy D2 gastrectomy.To provide a new model of treatment in the perioperative management of gastric carcinomaMETHODS: seventy-five patients diagnosed with GC between June 2014 and December 2016 were enrolled in this study and were divided into FTS and conventional care groups.All patients received elective standard D2 gastrectomy.The measures of fast track surgery is: preoperative education,no mechanical bowel,less time of abrosia,preparationthermal insulation,restricted fluid replacement,anesthesia method,early oral diet and early mobilization after surgery.The clinical parameters and serum indicators were compared.RESULTS: FTS was associated with shorter postoperative hospital stay [(17.17±9.27)d vs.(14.06±5.05)d,P=0.046],postoperative hospital stay in theory [(6.88±1.43)d vs.(7.91±1.54)d,P<0.01]shorter time to bowel function return [(4.56±1.16)d vs.(3.12±0.88)d,P<0.01],less stress response[(108.13±40.55 vs.79.01±37.10,P<0.01)postoperative day(POD)1],accelerated the decrease in serum albumin and lymphocyte count[(30.76±4.10 vs.32.56±3.20,p=0.04)(g/l)and(0.78±0.34 vs.0.98±0.36)(g/l),p=0.016)].The postoperative complications including ileus,anastomotic leakage,infection were similar(all P>0.05).CONCLUSION: FTS combined with laparoscopy D2 gastrectomy can promote faster postoperative recovery,improve early postoperative nutritional status,and more effectively reduce postoperative stress reaction,and is safe and effective for GC patients.