A Randomized Controlled Study Of The Effect On Immune Function Of ERAS Combined With Laparoscopic Radical Gastrectomy

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on postoperative immune function in patients undergoing laparoscopic radical gastrectomy,and whether to reduce postoperative complications and postoperative hospital stay,so that patients can get rapid recovery.Method This study was a prospective randomized controlled trial of 80 patients with laparoscopic radical gastrectomy performed at the Department of General Surgery,Second Affiliated Hospital of Lanzhou University from January2018 to January 2019,based on established inclusion criteria and exclusion criteria.Eighty patients were randomly divided into two groups,ERAS group and conventional group,including 40 patients in the ERAS group and 40 patients in the traditional group.The markers of immune function were measured before operation as well as on the before surgery,after surgery,1st and 3rd postoperative days(POD),including lymphocyte subpopulations(CD4 lymphocytes,CD8 lymphocytes,the CD4/CD8 ratio and NK lymphocytes)in the patients between the two groups.And record the patient's general information: age,gender,BMI,comorbidity,albumin,hemoglobin,tumor markers,TNM stage,surgical methods,number of lymph nodes,gastrointestinal reconstruction,operative time,nutrition risk screening(NRS2002),ASA score,Apfel score,New York Heart Association class(NYHA class),revised cardiac risk index(RCRI),metabolic equivalent(MET),preoperative VAS score,postoperative 1-3 days VAS score,postoperative complication,postoperative hospital stay,mortality,and the proportion of readmission within 30 days.At the same time,the compliance with the main elements of ERAS in the ERAS group were recorded.Results Compared with the conventional group,the ERAS group had no significant difference in age,gender,BMI,comorbidity,albumin,hemoglobin,tumor markers,TNM stage,surgical procedure,number of lymph nodes,gastrointestinal reconstruction,and operation time(P>0.05).There were no significant differences innutrition risk screening,NYHA class,RCRI,ASA score,MET,and VAS score between the two groups(P>0.05).However,there were significant differences in the Apfel score between the two groups(P<0.05).The Apfel score was used to evaluate the incidence of postoperative nausea and vomiting.The results showed that the conventional group had a higher probability of nausea and vomiting after surgery.The VAS scores on the 1st,2nd,and 3rd day after operation were significantly different between the two groups(P<0.05).The VAS score was higher in the conventional group.The incidence of postoperative complications was significantly different between the two groups(P<0.05),and the incidence of postoperative complications was relatively high in the conventional group.The postoperative hospital stay was significantly shorter in the ERAS group than in the conventional group(P<0.05).There were no deaths in the two groups,and there were no readmission patients within 30 days after discharge(P<0.05).The compliance with the ERAS protocol ranged from 30 to 100 % in ERAS group.Lower compliance rates include:no routine use of nasogastric tube(87.5%),no routine use of abdominal drain(30%),and start of an fluid diet on POD 1(80%).The lymphocyte subpopulations(CD4 lymphocytes,CD8 lymphocytes,the CD4/CD8 ratio and NK lymphocytes)in the ERAS group and the conventional group were compared.There was no significant difference in the preoperative lymphocyte subpopulations.The postoperative changes in CD4 lymphocytes,CD8 lymphocytes,and NK lymphocytes were less in the ERAS group(P>0.05).The CD4 lymphocytes of the conventional group on the after surgery,1st and 3rd POD were lower than the preoperative level,and the comparison with the ERAS group was also significantly lower(P<0.05).However,the CD8 lymphocytes of after surgery,1st and 3rd POD was significantly higher than that before surgery(P<0.05),and it was also significantly higher than ERAS group(P<0.05).The NK lymphocytes level in the conventional group decreased significantly on the after surgery and on 1st POD(P<0.05),and returned to the preoperative level on the 3rd POD,and the contrast with the ERAS group was also significantly lower(P<0.05).The CD4/CD8 ratio in the ERAS group was significantly lower than that before surgery(P<0.05),but it was significantly higher than the conventional group(P<0.05).There was no significant difference in CD4/CD8 ratio between 1st POD and 3rd POD(P>0.05).The CD4/CD8 ratio in the control group was significantly lower than that before surgery(P<0.05).And significantly lower than the level of the ERAS group at the same time(P <0.05).Conclusion ERAS has a protective effect on the immune function of patients undergoing laparoscopic radical gastrectomy,avoiding the inhibition of cellular immune level by surgical stress,reducing the pain of patients during the perioperative period,reducing postoperative complications and postoperative complications,so that patients can get rapid recovery.