Effect Of ERAS On Postoperative Outcomes Of Patients With Colorectal Cancer Complicated With Diabetes Mellitus

Objective:This experiment examined the effect of ERAS on clinical outcomes in patients with colorectal cancer with diabetes mellitus.The aim is to clarify the safety and effectiveness of ERAS in diabetic patients,and promote the perfection and promotion of ERAS concept.Methods:This experiment is a randomized controlled trial.The subjects were 97 patients admitted to the gastrointestinal surgery department of Qingdao Affiliated Hospital from January 1,2017 to December 31,2018.The patients were randomly divided into control group(48)and experimental group(49).The blood sugar of 97 patients was strictly controlled before operation.The experimental group was guided by ERAS concept in perioperative management,while the control group was treated routinely.The basic recovery,inflammatory reaction and nutritional status,insulin resistance and the incidence of complications were observed.Then we can draw a conclusion.The basic recovery after operation mainly monitored the length of hospital stay,hospitalization expenses,exhaust time and so on.Inflammation was detected by examining the levels of tumor necrosis factor-?(TNF-?),interleukin-6(IL-6),and C-reactive protein(CRP).Nutritional metabolic status mainly monitored the basic levels of albumin(ALB),prealbumin(PA),retinol binding protein(RBP).Postoperative insulin resistance was assessed by HOMA homeostasis model.Postoperative complications were graded by Clavien-Dindo classification.Results:Eighty-six patients completed the experiment(42 in the experimental group and 44 in the control group).In the experimental group,7 patients were excluded.One patient had invaded duodenum and could not be resected.One patient underwent palliative surgery for abdominal metastasis.Three patients did not follow ERAS concept after operation for personal reasons.Two patients underwent intraoperative exploration of tumors located in rectum.In the control group,4 patients were excluded,one patient had invaded right kidney and three patients underwent palliative surgery.The tumors were located in the rectum during the operation.There were no significant differences in operation time,intraoperative bleeding volume,tumor location and tumor stage between the two groups.Through the analysis of the experimental results,the total postoperative exhaust time of the experimental group(53.69 ±10.05h)was significantly shorter than that of the control group(65.59 ±15.50h).The exhaust time of the right and sigmoid colon experimental group was shorter than that of the control group,while the transverse colon and the left colon could not be compared because of the small number of patients.The discharging time of the experimental group(6.02 ±1.35d)was significantly faster than that of the control group(7.89 ±1.69d),and the hospitalization expenditure of the experimental group(40.30 ±3.16k)was significantly lower than that of the control group(45.63 ±3.85k).The difference was statistically significant.There were no significant differences in CRP,IL-6 and TNF-alpha before operation between the two groups.CRP was significantly higher in the control group than in the experimental group on the first day and the third day after operation,and there was no significant difference on the seventh day;IL-6 was significantly higher in the control group than in the experimental group on the first,third and seventh day after operation;TNF-alpha was higher in the control group on the third and seventh day after operation than in the experimental group,but there was no significant difference on the first day after operation.There was no significant difference in ALB,PA and RBP before operation between the two groups.There was no significant difference in preoperative insulin resistance index and islet beta cell function between the two groups.After operation,insulin resistance in both groups increased and decreased.The change of insulin resistance in the experimental group was smaller than that in the control group,and the decrease was more obvious.There was no significant difference between the two groups.The function of islet beta cells recovered faster in the experimental group than in the control group.The incidence of diarrhea,constipation,fever and lower extremity venous thrombosis in the experimental group was significantly lower than that in the control group.The difference was statistically significant.There was no significant difference in the incidence of other postoperative complications.According to Clavien-Dindo classification,the incidence of complications in the experimental group was lower than that in the control group.Conclusion:This experiment mainly observes the influence of ERAS concept on the recent clinical outcomes of patients with colon cancer complicated with diabetes mellitus,and clarifies the safety and effectiveness of ERAS concept for diabetic population.The results of the experiment are statistically different.ERAS concept can accelerate the recovery of gastrointestinal function,significantly shorten hospitalization days,reduce hospitalization costs;reduce inflammation stress response of patients,improve nutritional status of patients after surgery;can reduce insulin resistance of patients after surgery.At the same time,ERAS concept can ensure patient safety and reduce postoperative complications.However,the mechanism of ERAS concept in accelerating the rehabilitation of diabetic patients remains to be further explored.