Retrospective Study Of Fast-track Surgery Applied In The Perioperative Period Of Elderly With Advanced Gastric Carcinoma

Objective:The aim of this study is to investigate the effectiveness and safety of FTS(Fast Track Surgery)in the elderly patients with advanced gastric cancer in perioperative.Method: Studies were performed between January 2013 and June 2016 in 122 elder patients(older than 60 years)with advanced gastric carcinoma in the gastrointestinal tumor surgery of the First Affiliated Hospital of Henan University of Science and Technology.65 patients received FTS,includes preoperative education concept of FTS,before operation took 250 ml glucose orally 2 h before operation,no enema,optimization of anesthetic methods and drugs,intraoperative warming,restrictive transfusion,early ambulation and early eating.and 57 patients given conventional management,includes take regular mission,fasting for 8 h,routine preoperative enema,conventional surgery preparation,conventional general anesthesia,early exercise following patients’ will and Eating after ventilation).The FTS group(48 male and 17 female,the mean age was 69.4 ± 6.8),control group(44 male and 13 female,the mean age was 67.4 ± 5.2).Two groups of sex and age had no statistical significance(P>0.05).All operations are completed by the same team,all the patients were in operation on gastroscopy parallel pathological detection of gastric cancer.The postoperative pathology of all the patients were advanced gastric cancer.All patients underwent D2 lymphadenectomy.The operation situation,postoperative recovery and stress degree of both groups were compared.Results:1.The results showed that in the FTS group operation time(min)(222.08±46.07 VS 220.79±42.51 in controls,P>0.05),intraoperative blood loss(ml)(210.62±132.11 VS 211.58±114.42 in controls,P>0.05),number of lymph node dissected(n)(32.43±11.24 VS 29.86±9.42 in controls,P>0.05),they had no statistical significance,but the anesthesia time(240.07±45.25 VS 257.11±45.51 in controls,P=0.039)with statistical significance.2.The results showed that in the FTS group the average length of hospital stay(d)the two groups after surgery(13.74±3.2 VS 17.39±4.68 in controls,P=0.000),the total cost of hospitalization(ten thousand[RMB])(2.54±0.31 VS 2.92±0.44 in controls,P=0.000),time of ventilation(h)(71.23±11.85 VS 93.65±12.98 in controls,P=0.000),postoperative indwelling gastric tube time(h)(11.37±7.75 VS 107.26±7.82 in controls,P=0.000),the removal time of the peritoneal drainage pipes(h)(25.48±8.35 VS 74.95±10.21 in controls,P=0.000)has significant statistical significance,but postoperative intestinal obstruction,infection,such as anastomotic fistula and postoperative complication rate of 30 d return to hospital no statistical significance(P>0.05).3.The results showed that in the both group preoperative WBC and CRP has no obvious difference(P>0.05),but in the FTS group WBC(×109/L)POD 1(13.86±2.02 VS 19.30±2.66 in controls,P=0.000),POD 3(11.18±2.17 VS 16.25±3.62 in controls,P=0.000),CRP(mg/L)POD 1(9.43+1.33 VS 2.61±1.42 in controls,P=0.000),POD 3(5.55+2.27 VS 9.81±2.40 in controls,P=0.000)have significant statistical significance,stress index decreased obviously.Conclusion: These results indicate that application of the FTS in in the elderly patients with advanced gastric cancer efficiently accelerates postoperative recovery.including reduction of anesthesia duration,fusion volume and postoperative ventilation time,decreased hospital stays and costs(P<0.05),and the stress indicators,such as leukocyte and C-reactive protein(CRP),were also lower.But for both group,the including operation time,blood loss,number of lymph node dissection and the postoperative complication rates of intestinal obstruction,infection and anastomotic leak were not statistically significant at all.It’s safety and effective for providing FTS to elderly patients with advanced gastric cancer perioperative management.This approach is worthy for promotion in clinical.