| Background: Fast-track surgery(FTS) is a multimodal perioperative carepathway designed to achieve early recovery for patients undergoing majorsurgery. FTS aims to reduce traumatic stress and postoperative complications,improve full recovery of patients or combine and coordinate evidence-basedperioperative care interventions that support standardizing and optimazingsurgical care.Although FTS has been applied in colonical and rectal surgery, itis limited in gastrectomy. There is no definite applicative range of FTS forgastrectomy, one important issue of applicative range of FTS for gastrectomyneed to be clear, which will promote the application of FTS in clinic.Objective:（1）To study the safety and feasibility of fast track surgery(FTS) inthe promotion of postoperative recovery for laparoscopic distal gastrectomy forgastric cancer patients undergoing gastrectomy（.2）To study the significance ofthe amount of gastrointestinal decompression and gastric residual for FTS inthe laparoscopic distal gastrectomy for gastric cancer.Methods: This is a retrospective study. From2013May to2015January,147patients diagnosed gastric cancer in the First Hospital of Jilin University wereenrolled in this study.All patients were divided into two groups:FTSgroup(n=72) and TS group(n=75) according the perioperative treated model, and the patients of FTS group underwent FTS and the patients of TS groupunderwent traditional treated model. Then all patients were divided into4group:FTS1group(n=54), TS1group(n=56), FTS2group(n=18) and TS2group(n=19) according to the perioperative treated model and the amount ofgastrointestinal decompression and gastric residual. The patients of FTS1groupwhose amount of gastrointestinal decompression and gastric residual less than100ml after operation6h underwent FTS, and the patients of TS1group whoseamount of gastrointestinal decompression and gastric residual less than100mlafter operation6h underwent TS, and the patients of FTS2group whose amountof gastrointestinal decompression and gastric residual more than100ml afteroperation6h underwent FTS, and the patients of TS2group whose amount ofgastrointestinal decompression and gastric residual more than100ml afteroperation6h underwent TS.All patients’demographic characteristics data,surgical outcomes, and postoperative data were analyzed.Results:(1)FTS group and TS group were identical in demographiccharacteristics(p>0.05). There were no statistical difference between twogroups in operation time, number of harvested lymph nodes，blood loss and redblood cell transfusion(p>0.05), but venous transfusion of FTS group was lessthan TS group(1119.51±136.74ml vs.1886.33±318.82ml, p<0.01), and thetime of removing stomach tube of of FTS group was less than TS group(6.00±0.00h vs.95.89±13.46h, p<0.01), and the time of first walking of FTS groupwas less than TS group(1.00±0.00d vs.2.48±0.95d, p<0.01), and the time of liquid diet of FTS group was less than TS group(1.47±0.71d vs.2.57±0.76d,p<0.01), and postoperative hospital stay of FTS group was less than TSgroup(5.93±1.86d vs.8.45±1.97d, p<0.01), and the time of first flatus of FTSgroup was less than TS group(2.14±0.7d vs.2.56±0.7d, p<0.01), and thecomplications of two groups were no significance(16.67%vs.9.21%, p>0.05),and the cost of FTS group was less than TS group(4.95±0.39wanyuan vs.5.41±0.63wanyuan, p<0.01), and there were no significance in readmission of twogroup(13.89%vs.8.00%, p>0.05).(2) FTS1group and TS1group wereidentical in demographic characteristics(p>0.05). There were no statisticaldifference between two groups in operation time, number of harvested lymphnodes，blood loss and red blood cell transfusion(p>0.05), but venoustransfusion of FTS1group was less than TS1group(1113.24±90.29ml vs.1952.4±309.57ml, p<0.01), and the time of removing stomach tube of ofFTS1group was less than TS1group(6.00±0.00h vs.95.29±12.32h, p<0.01),and the time of first walking of FTS1group was less than TS1group(1.00±0.00d vs.2.34±0.94d, p<0.01), and the time of liquid diet of FTS1group wasless than TS1group(1.15±0.41d vs.2.48±0.76d, p<0.01), and postoperativehospital stay of FTS1group was less than TS1group (5.54±1.46d vs.8.55±2.00d, p<0.01), and the time of first flatus of FTS1group was less than TS1group(2.13±0.73d vs.2.48±0.76d, p<0.05), and the complications of twogroups were no significance(11.11%vs.10.71%, p>0.05), and the cost of FTS1group was less than TS1group(4.94±0.38wanyuan vs.5.42±0.67wanyuan, p<0.01), and there were no significance in readmission of two groups(7.41%vs.8.93%, p>0.05).(3) FTS2group and TS2group were identical in demographiccharacteristics(p>0.05). There were no statistical difference between twogroups in operation time, number of harvested lymph nodes，blood loss and redblood cell transfusion(p>0.05), but venous transfusion of FTS2group was lessthan TS2group(1138.33±28.40ml vs.1692.37±268.10ml, p<0.01), and thetime of removing stomach tube of of FTS2group was less than TS2group(6.00±0.00hvs.95.68±16.67h, p<0.01), and the time of first walking of FTS2group was less than TS2group(1.00±0.00d vs.2.89±0.88d, p<0.01), andthere were no significance in the time of liquid diet(2.44±0.51d vs.2.84±0.69d, p>0.05) and postoperative hospital stay(7.11±2.40d vs.8.16±1.89d,p>0.05) of two groups, and the time of first flatus of of FTS2group was lessthan TS2group (2.17±0.86d vs.2.79±0.79d, p<0.01), and the complicationsof FTS2were more than TS2group(33.33%vs.5.26%, p<0.05), and the cost ofFTS2group was less than TS2group(4.96±0.45wanyuan vs.5.37±0.53wanyuan, p<0.05), and readmission of FTS2group was more than TS2group(33.33%vs.5.26%, p<0.05).Conclusion:Fast-track surgery with laparoscopic radical gastrectomy for distalgastric cancer is safe and feasible and promotes patients’recovery. FTS is moreproper for the patients whose amount of gastrointestinal decompression andgastric residual less than100ml at postoperative6h after laparoscopic radicalgastrectomy for distal gastric cancer, and traditional surgical treatment model is more proper for the patients whose amount of gastrointestinal decompressionand gastric residual more than100ml. |
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