The Effects Of Enhanced Recovery After Surgery On The Short-term Outcomes Of Laparoscopic Gastrectomy

Objective By observing the effects of perioperative enhanced recovery after surgry(ERAS)protocol on the postoperative stress indicators and nutritional indicators of patients undergoing laparoscopic radical gastrectomy,combined the postoperative recovery indicators,we summarized the effects of ERAS on the short-term outcomes of laparoscopic gastrectomy.Methods A total of 100 gastric cancer patients were recruited from July 2019 to April 2020 in the Department of Gastrointestinal Surgery,Weihai Central Hospital,Eighth Clinical College of Qingdao University.The patients were divided into ERAS group and non-ERAS group randomly.The experimental group and the control group were enrolled in a random list of PASS 11.0 according to the number of valid target cases 1: 1.The experimented group was treated with laparoscopic assisted radical gastrectomy + ERAS protocol.The control group was managed according to laparoscopic assisted radical gastrectomy + traditional perioperative management(NonERAS group).The patients in two groups were underwent consistently.After discharge,the patient was followed up in the outpatient clinic to 30 days after surgery.The basic recovery indicators,stress response,nutritional status,and postoperative complications indicators were recorded to draw a conclusion.The postoperative clinical outcome indicators include postoperative pain score at 24 hours,the time of first intestinal ventilation,defecation and eating after operation,the length of hospital stay after surgery,and the cost of treatment.The stress response indicators mainly include white blood cell count,C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-?(TNF-?).The nutritional indicators mainly include serum prealbumin,albumin,and lymphocyte counts.Postoperative complications indicators include postoperative complications and the evaluation with the Clavien-Dindo surgical complication classification system,and the record of reoperation,rehospitalization and death.Results A total of 96 patients finally entered the study,48 patients in each group.There were no obvious differences between the two groups in terms of gender,age,body mass index(BMI),nutritional risk,and ASA score,and the differences were no sense of statistics(P> 0.05),indicating that the two groups of patients had no obvious difference in preoperative status.There were no obvious differences between the two groups in terms of surgical approach,anastomosis method,operation time,intraoperative blood loss,number of lymph nodes removed and tumor TNM staging(P> 0.05),indicating that the two groups of patients had little difference in surgical treatment.The surgical results were similar in the two groups.There was no statistically significant distinction in the incidence of complications and serious complications.There was no significant difference between the two groups in readmission and reoperation within 30 days,and no patients died.Compared with the control group,patients in the ERAS group had less postoperative pain,earlier time of first intestinal ventilation and defecation,earlier time of eating,shorter postoperative hospital stay,and lower hospitalization cost(P <0.05).Before operation,the levels of white blood cell count,CPR,IL-6 and TNF-? were not significantly distinction between the two groups.There were no obvious differences in TNF-? between the two groups before and after operation(P> 0.05).Compared with the control group,the levels of CRP and IL-6 in the ERAS group had lower rise on the third day after operation(P <0.05),and the distinction in the increase in the white blood cell count did not reach sense of statistics(P> 0.05).There were no obvious differences in the counts of prealbumin,blood albumin,and lymphocytes between the two groups before the operation.Compared with the control group,the decrease of the ERAS group in the levels of the serum prealbumin,albumin,and lymphocyte counts on the third day was smaller(P <0.05),and these three indexes recovered to the levels before the operation on the fifth day after the operation.Conclusion The application of the ERAS concept to perioperative management of laparoscopic gastrectomy is safe and feasible.It accelerates the postoperative recovery of patients,makes the perioperative stress response of patients lighter,and makes the effect on the nutritional status less.Therefore,the application of the ERAS concept to perioperative management of laparoscopic gastric cancer radical surgery may be beneficial to the control of postoperative gastric cancer progress,and further observation research on long-term effects may be carried out.