The Effect Of Enhanced Recovery After Radical Surgery For Advanced Gastric Cancer Receiving Neoadjuvant Chemotherapy

Objective:The application of enhanced recovery after surgery(ERAS)in perioperative management of gastric cancer patients has been increasing,but it remains uncler for those receiving neoadjuvant chemotherapy.The intention of this study is to probe into the consequence of ERAS pathway on the short-dated outcomes of patients with advanced gastric cancer went through radical surgery after neoadjuvant chemotherapy,and to weigh up whether the ERAS pathway in advanced gastric cancer can be applied to patients receiving neoadjuvant chemotherapy.Method:This retrospective cohort study included 96 advanced gastric cancer patients went through radical surgery in our hospital from January 1,2017 to December 31,2020.All patients received 2-4 cycles of neoadjuvant chemotherapy before operation,including 30 cases of ERAS management route and 66 cases of regular treatment route.30 patients who implemented ERAS management route after 1:1adapting by PSM method were set as observation group,and 30 patients who implemented conventional treatment route was set as a control group.The perioperative indicators of the two groups,including postoperative recovery time and short-dated complications,were gathered and contrasted.Result:1.There was no significant difference regarding preoperative general information,tumor location,terms of lymph node dissection,Operative duration,estimated blood loss,operation procedure,digestive tract reconstruction mode,feeding stoma,number of drainage tubes,postoperative protein,postoperative hemoglobin,postoperative albumin,postoperative complications,complication scoring system classification,R0 resection rate,degree of tumor regression and pathological staging between the two groups(P > 0.05).2.Compared with the control group,time to ambulation(1.5 ± 0.6 days vs.3.2± 1.1 days),the first oral liquid time(1.53 ± 0.5 days vs.3.5 ± 1.6 days)and the first oral semi liquid time(3.16 ± 0.5 days vs.6.1 ± 1.5 days)of the observation group were significantly earlier(P < 0.05).In addition,the total intraoperative urine volume(321.7 ± 111.2 ml vs.436.7 ± 151.2 ml)and total intraoperative fluid infusion volume(1620.0 ± 278.0 ml vs.1900 ± 389.5 ml)of patients in the observation group were less,the hospitalization expenses were less(66215.1 ±18139.9 yuan vs.86599.9 ± 29034.8 yuan),and the patients’ satisfaction was higher(967 ± 1.5 points vs.93.7 ± 1.5 points)(P < 0.05).3.In the observation group,stratified analysis showed that there were significant reletion between the compliance with preoperative nutritional support,and oral intake on the first day after operation and postoperative complications(50.0% vs.95.0%,P < 0.05;30.0% vs.90.0%,P < 0.05).Interestingly,a significant negative correlation was observed between the length of hospital stay and the total compliance with all eras items(P < 0.05).In addition,in terms of postoperative recovery,the effect of three cycles of preoperative neoadjuvant chemotherapy was significantly better than that of only two cycles(P < 0.05).Conclusion:It is safe and feasible to implement radical surgery combined with accelerated rehabilitation surgery management for advanced gastric cancer receiving neoadjuvant chemotherapy.It can accelerate postoperative functional recovery,shorten postoperative hospital stay and reduce hospital costs,thus improving patient satisfaction,without increasing postoperative events.