Application of enhanced recovery program after surgery in patients undergoing elective radical resection for gastric cancer
10.3760/cma.j.issn.1006-9801.2015.12.001
- VernacularTitle:促进术后恢复综合方案在择期胃癌根治术患者中的应用
- Author:
Yang YANG
;
Xianwei MO
;
Jiansi CHEN
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Surgical procedures;
Enhanced recovery program after surgery;
Stress
- From:
Cancer Research and Clinic
2015;27(12):793-797
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the stimulative role of the enhanced recovery program after surgery (ERAS) protocol in patients undergoing radical resection for gastric cancer.Methods A total of 102 consecutive patients undergoing elective gastric resection were included in either the ERAS (n =35,received ERAS perioperative treatment from June 2013 to June 2014) or the control group (n =67,received conventional perioperative treatment from June 2011 to June 2013).Outcomes related to nutrition index,stress index,and recovery index were measured.Results The nutritional index of patients (total lymphocyte count,serum albumin and prealbumin) in the ERAS group was improved on postoperative day (POD) 1 compared with that in the control group [(1.25±0.65) × 109/L vs (1.09±0.71) × 109/L,(36.4±5.2) g/L vs (31.3±4.1) g/L,(0.19±0.08) g/L vs (0.17±0.05) g/L,P ＜ 0.05,respectively].The level of negative nitrogen balance on POD 1 in the ERAS group was slightly lower than that in the control group (P ＞ 0.05),and the level of negative nitrogen balance on POD 7 in the ERAS group was higher than that in the control group (-0.93±2.17 vs -3.87±4.45,P ＜ 0.05).The postoperative cortisol level in the control group was elevated on both POD 1 (P ＜ 0.05) and POD 7 (P ＜ 0.05) compared to the preoperative level [(5.06±1.87) mg/L vs (3.60±1.5) mg/L],(5.15±1.33) mg/L vs (3.60±1.51) mg/L,P ＜ 0.05,respectively].However,the cortisol level was not increased until POD 7 in the ERAS group [(5.08±1.18) mg/L vs (3.20±1.43) mg/L,P ＜ 0.05].The level of IL-6 was elevated in postoperative period compared to preoperative period both in two groups (P ＜ 0.05).And the level of IFN-γin the ERAS group on POD 1 was reduced compared to the preoperative level (P ＜ 0.05).Whether in preoperative or postoperative,the level of IL-1β and TNF-α showed no statistical significance change.In addition,the postoperative recovery conditions (day of oral all-liquid recovery,first day of defecation,hospital stay,maximum pain on visual analogue scale) in the ERAS group were better than those in the control group (P ＜ 0.05).The incidence rates of complications between the two groups were 13.4 ％ (9/67) and 17.1％ (6/35) respectively (P ＞ 0.05).Conclusion ERAS protocol can alleviate surgical stress response and accelerate postoperative recovery without compromising patients' safety.
