Clinical Study Of Early Oral Feeding After Laparoscopic-assisted Radical Total Gastrectomy For Elderly Patients With Gastric Cancer

Objective: To investigate the safety and clinical efficacy of early oral intake(EOF)in elderly patients with gastric cancer undergoing laparoscopic-assisted radical total gastrectomy.Methods: Retrospectively included 129 elderly patients with gastric cancer(age 60-80 years old)undergoing laparoscopic-assisted radical total gastrectomy from June 2014 to June 2017 in our hospital.There were 90 males and 39 females with an average age of 66.74±5.06.year old.Among them,53 cases took out the stomach tube on the 1st day after surgery and began to drink and eat.The dietary program that gradually transitioned from liquid to semi-liquid was defined as early oral feeding(EOF)group,and 76 cases were treated with anus exhaust.The dietary plan for the gradual transition from liquid to semi-liquid after the gastric tube was removed was defined as the traditional feeding(TF)group.Comparing the general conditions of the two groups,the intraoperative index,the first time after the bed was removed,the time for removing the abdominal drainage tube,the first time after the operation,the first postoperative defecation time,the postoperative hospital stay,and the nutritional index before and after surgery [(Preoperative,postoperative 1d,postoperative 7d)albumin(ALB),pre albumin(PA),total lymphocyte count,pre-and post-operative stress indicators [(preoperative,postoperative 1d,7-day postoperative C-reactive protein(CRP),incidence of gastrointestinal intolerance(bloating or re-introduction of gastrointestinal decompression tubes),postoperative complications(anastomotic fistula,Intestinal obstruction,incision infection,abdominal infection,etc.)Results: 1.Comparison of general conditions: There were 37 males and 16 females in the EOF group,with an average age of(66.89±4.66)years.There were 53 males and 23 females in the TF group with an average age of(66.63±5.36)years.There was no significant difference in gender and age between the two groups(P>0.05).The preoperative body mass index(BMI)[(21.76±2.19)kg/m2 vs(22.12±2.32)kg/m2,P>0.05] and the tumor node metastasis(TNM)staging of the two groups(?2=3.096,P>0.05),ASA score(?2=0.018,P>0.05),nutritional risk assessment(?2=0.019,P>0.05),the differences were not statistically significant.2.Comparison of intraoperative indexes: The operative time of the two groups was [(231.74±10.16)min vs(234.34±11.37)min,P>0.05)],intraoperative blood loss [(151.32 ± 82.70)ml vs(180.72 ± 119.91)ml,P>0.05],the number of intraoperative lymph node dissections [(28.60±5.10)vs(27.63±3.89),P>0.05],the differences were not statistically significant.3.Comparison of post-operative recovery index: The first postoperative bedtime of the two groups was [(17.57±3.41)h vs.(17.91±3.61)h,P>0.05],and the drainage tube removal time was [(3.77±0.72)d vs(4.01±0.70)d,t=-1.882,P>0.05],the differences were not statistically significant.The first postoperative degassing time was [(1.96±0.78)d vs.(3.34±0.97)d,t=-8.561,P<0.001],and the first postoperative defecation time [(2.92±0.78)d vs(4.61±0.97)d,t=-10.487,P<0.001],postoperative hospital stay[(7.60 ± 1.28)d vs(10.09 ± 2.69)d,P<0.001],the differences were statistically significant.4.Comparison of nutritional parameters: There was no significant difference in preoperative and postoperative 1st day ALB,PA levels and total lymphocyte counts(P>0.05).Postoperative 7th day of ALB [(33.66±2.64 g/L vs(30.74±2.57)g/L,P<0.001],PA at postoperative 7th days [(173.00±9.04g/L vs 161.74±10.84g/L,P<0.001),total lymphocyte count at postoperative 7th days(×109/L)[1.56±0.34)×109/L VS(1.29±0.40)×109/L,P<0.001],the differences were statistically significant.5.Comparison of stress indicators: There was no significant difference in CRP levels of preoperative and postoperative 1th days(P>0.05).The CRP level of 7 days after operation was[(50.92±5.75)mg/L vs(58.21±6.79)mg/L,P<0.001],Differences were statistically significant.6.Comparison of the incidence of gastrointestinal intolerance and complications: incidence of abdominal distension after operation in both groups(7.5% vs 6.6%,?2=0.05,P>0.05).The two groups were rieinserted into the stomach tube.The incidence of complications(3.8% vs 2.6%,?2=0.14,P>0.05),postoperative complications(7.7% vs 6.2%,?2=0.11,P>0.05)were not statstically different.Conclusion:Early oral feeding after laparoscopic-assisted radical total gastrectomy for elderly patients with gastric cancer is safe and feasible.Under the premise of not increasing gastrointestinal intolerance and postoperative complications,it will help improve postoperative nutritional status and reduce postoperative Excitation levels promote postoperative recovery of gastrointestinal function and shorten postoperative hospital stay.