Gastric cancer is one of the most serious health problems in China. The overall survival rate after surgical treatment has increased and the rate of postoperative complication has decreased. These improvements are due to the introduction of more radical surgical techniques, early detection, and the improvement of anesthesia, perioperative care, and nutritional support. The aim of this article is to introduce the general perioperative management of patients with gastric cancer. Good perioperative management of gastric cancer contributes to the improvement of surgical outcomes. There are several controversial issues in the general perioperative management of gastric cancer, such as gastric tube decompression and nutritional support.
Humans ; Perioperative Care ; methods ; Stomach Neoplasms ; surgery

Humans ; Monitoring, Intraoperative ; methods ; trends ; Perioperative Care ; methods ; trends

The author raised that the orientation of peri-operative integrative medicine studies as: Correct surgical decision-making is the prerequisite for successful surgery, the skilled surgical technique is the key for successful operation. At the same time, considerate and appropriate peri-operative management is the guarantee for the success of surgery. Consequently, quick recovery is the core concept of peri-operative integrative medicine studies. Its academic value and practical significance lie in that it can accelerate the improvement of surgical skills, optimize various effective measures to improve the overall efficacy, promote discipline construction and personnel training to improve academic levels, promote the development of Chinese medicine and accelerate its internationalization.
Humans ; Integrative Medicine ; Perioperative Care ; methods ; Rehabilitation ; methods

The excess fatty tissues on the head, neck, thorax, and abdomen of morbid obese patients can impede the patency of the upper airway and impair lung functions. Meanwhile, these patients often have comorbidities such as obstructive sleep apnea, hypoventilation syndrome, chronic obstructive pulmonary disease, and asthma, which may result in difficult airway, intraoperative hypoventilation, and postoperative respiratory depression. Therefore, perioperative airway management for morbid obese patients may pose a big challenge to anesthesiologists. Anesthesiologists should know well about the pathophysiological features of respiratory system and grasp rational management principles, so as to improve the safety and effectiveness of perioperative airway management and optimize the clinical prognosis.
Airway Management ; Anesthesia ; methods ; Humans ; Obesity ; surgery ; Perioperative Care

Fluid therapy is one of the most controversial topics in perioperative management. Current perioperative fluid therapy is largely based on concepts developed restricted and liberal perioperative fluid administration in the late 1950s and 1960s. However, there are increasing reports of perioperative excessive intravascular volume leading to increased postoperative morbidity and mortality. The concept of individualized goal-directed therapy in surgical patients seems to be an important component for optimization of perioperative fluid management in high-risk surgical patients.
Fluid Therapy ; adverse effects ; methods ; Humans ; Perioperative Care

Recently immunotherapy for gastrointestinal tumor has rapidly developed, and has improved the effect of cancer comprehensive treatment as an adjunctive therapy in combination with surgery, chemotherapy, and radiation therapy. Adoptive transfer of immune cells is an important treatment method for advanced gastric cancer. In this paper, we reviewed the application of adoptive transfer therapy for advanced gastric cancer in the perioperative period and propose a new model for immunotherapy of advanced gastric cancer based on our experience and the results of clinical experiment.
Humans ; Immunotherapy, Adoptive ; methods ; Perioperative Care ; Stomach Neoplasms ; therapy

Metabolic surgery is a gastrointestinal surgical procedure to treat obesity and its related co-morbidities with rapid development in recent years. Patients undergoing metabolic surgery have preoperative nutritional disorders, and the nutrition management for these patients is the key point of perioperative management. During the perioperative period, current research has preliminarily confirmed that perioperative managements including supplementation of micronutrients, preoperative evaluation of the weight loss, preoperative fasting and carbohydrate oral intake based on the full application of ERAS and characteristics of the patients undergoing metabolic surgery, are safe and effective in clinical practice. As for the postoperative diet strategy, current literature remains non-unified to identify the duration and the content of the nutrition managements. Domestic clinical reports about the postoperative nutrition managements after metabolic surgery are rare and lack of unified and good reference standard. Meanwhile, divergence still existed in current literature regarding to the content of the postoperative nutrition managements. Therefore, it is necessary to develop the standardized protocol for nutrition managements which is offering basis and reference for the clinical application of perioperative nutrition managements after metabolic surgery.
Bariatric Surgery ; Digestive System Surgical Procedures ; Humans ; Nutrition Therapy ; methods ; standards ; Perioperative Care ; methods ; standards

Gastric cancer is a common digestive system malignancy. Surgical operation is the main treatment of radical treatment for gastric cancer. Pulmonary infection is a common postoperative complication of gastric cancer. Because there is no clear and unified definition of pulmonary complications, the current researches show that the incidence of postoperative pulmonary infection of gastric cancer is about 1.8%-18.1%. The incidence of postoperative pulmonary infection will prolong the hospital stay, increase the cost of hospitalization, and even develop into respiratory failure leading to early postoperative death. There are many factors affecting postoperative pulmonary infection of gastric cancer, including age, smoking history, pulmonary function, pulmonary disease history, operation method, operation time, intraoperative bleeding volume, gastric tube retention time, postoperative lying time and so on. There are also many perioperative interventions. This article reviews the risk factors and perioperative interventions of postoperative pulmonary infection of gastric cancer.
Gastrectomy/adverse effects* ; Humans ; Perioperative Care/methods* ; Pneumonia/therapy* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/surgery*

Enhanced recovery after surgery (ERAS) has been widely used in perioperative optimization. As an important component of ERAS, rehabilitation medicine mainly focuses on perioperative physical fitness management, respiratory training, exercise training to reduce the incidence of postoperative pulmonary infection, improve gastrointestinal and cardiopulmonary function. This paper explains rehabilitation medicine for respiratory, musculoskeletal, cardiovascular and digestive systems during the perioperative period.
Humans ; Perioperative Care ; Postoperative Complications ; prevention & control ; Postoperative Period ; Rehabilitation ; methods ; standards

The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care pathway, which is to reduce the perioperative stress and metabolic variation, with the ultimate goal of improving patient recovery and outcomes. This article reviews some hot issues in the clinical practice of ERAS in China. Currently, the concept and pathways of ERAS are very consistent with China's medical reform, and the basic principle of "safety first, efficiency second" should be adhered to. In specific clinical practice, multidisciplinary cooperation, the improvement of surgical quality and the implementation of prehabilitation pathway should be advocated. In addition, the ERAS approaches should be implemented individually to avoid mechanical understanding and dogmatic implementation. The implementation of ERAS and its clinical outcome should be audited to accumulate experience, and a feedback mechanism should be established to improve the outcome continuously. In clinical practice, "fast recovery" should not be the sole purpose. For patients, the decrease in the risk of readmission rate is more important as compared to discharge rate. Additionally, the disparities between the development of ERAS clinical research in China and that in the world are also analyzed in this review. A national ERAS database should be established on the basic platform of academic groups to ensure the development of high-quality clinical research in China.
Critical Pathways ; Enhanced Recovery After Surgery ; Humans ; Length of Stay ; Perioperative Care/methods* ; Postoperative Complications