| Objective: Perioperative nutrition was a significant part of ERAS pathway for gastric cancer patients.However,there is no uniform clinical standard for the starting time and schedule of oral nutrition after gastric cancer surgery.The aim of this study was to examine the effect of postoperative quantitative diet management on short-term complications in enhanced recovery after surgery for gastric cancer.Methods: 85 gastric cancer patients who underwent gastrectomy in the Department of gastrointestinal surgery of the First Affiliated Hospital of Fujian Medical University from January 2018 to December 2019 were classified into two groups according to random number method: control group under non-quantitative diet management(n=40)and observation group under quantitative diet management(n=45).And,the observation group was divided into the complication group(n=6)and the non-complication group(n=34).The primary outcome measures included daily oral intake and targets completion of three days after surgery,postoperative complications including local and systemic complications,Clavien-Dindo classification.Secondary outcomes included pre-,intra-,and postoperative outcomes.Result: 1.There were no significant differences in terms of postoperative complication,Clavien-Dindo Classification,postoperative albumin,postoperative hemoglobin,pathological stage,ERAS complicance,preoperative and intraoperative parameter between two groups(p>0.05).2.Compared with control group,patients in observation group had earlier mobilization(3.2±3.4 days vs 2.1±1.0 days,p=0.030),earlier passe of flatus(3.0±1.6 days vs 2.1±0.8 days,p=0.001),shorter postoperative hospital stay(14.8±7.3 days vs 10.4±3.3 days,p=0.001)and less hospital expenses(88±21 thousand yuan vs 78±15 thousand yuan,p=0.001),but more daily oral intake after surgery(day 1,91.8±43.6 ml vs 185.8±75.3 ml,p<0.001;day 2,216.4±82.9 ml vs 434.8±147.8 ml,p<0.001;day 3,420.4±123.9 ml vs 770.0±206.4 ml,p<0.001),more total oral intake after surgery(728.7±150.0 ml vs 1390.5±339.4 ml,p<0.001)amd more daily target compliance of oral intake(day 1,0 vs 4,p=0.045;day 2,0 vs 6,p=0.09;day 3,0 vs 15,p<0.001).Compared with non-complications in observation group,patients with complications in observation group had higher proportion of education level under high school(67.6% vs 100%,p=0.039),higher proportion of preoperetive retaining gastric tube(100% vs 66.7%,p=0.019),but later mobilization(1.9±0.8 days vs 3.3±1.4 days,p=0.015),later passe of flatus(2.0±0.7 days vs 3.0±1.1 days,p=0.022),longer postoperative hospital stay(9.8±2.7 days vs 14.0±4.1 days,p=0.012)and more hospital expenses(74±13 thousand yuan vs 99±10 thousand yuan,p<0.001).In addition,patients with complications had less daily oral intake after surgery(day 1,200.3±69.3 ml vs 103.3±53.9 ml,p=0.004;day 2,468.5±131.7 ml vs 243.3±64.1 ml,p<0.001;day 3,823.8±171.0 ml vs 465.0±89.4 ml,p<0.001),less total oral intake after surgery(1498.7±242.0 ml vs 811.7±197.8 ml,p<0.001),less target compliance of oral intake in postoperative day 3(15 vs 0,p=0.042),less albumin level(32.4±3.1 g/L vs 29.4±4.2 g/L,p=0.042)and less postoperative hemoglobin level(116.3±15.1 g/L vs 96.8±16.3 g/L,p=0.007)in postoperative day 3.No statistical difference was found in other perioperative indicators(p>0.05).Conclusions: Postoperative quantitative diet management in enhanced recovery after surgery for gastric cancer was safe and feasible.It can improve the patient’s food intake,shorten the first time out of bed,exhaust time,the postoperative hospital stay and total hospital expenses,without increasing postoperative complications.. |
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