Application Of Enhanced Recovery After Surgery (ERAS) Concept In Radical Gastrectomy For Gastric Cancer

Objective:Enhanced recovery after surgery(ERAS)has been widely used in colorectal surgery at home and abroad,but its application in in radical gastrectomy for gastric cancer is just beginning.The purpose of this study is to investigate the safety and effectiveness of ERAS in radical gastrectomy for gastric cancer.Method:Eighty-seven patients were admitted to the Affiliated Hospital of Jiangsu University from July 2018 to June 2019 and received radical gastrectomy for gastric cancer.These patients were randomly divided into 4 groups:(1)21 cases in the ERAS+LAG group accepted laparoscopic assisted radical gastrectomy and ERAS perioperative treatment;(2)21 cases in the LAG group accepted laparoscopic assisted radical gastrectomy and traditional perioperative treatment;(3)26 patients in ERAS+ OG group accepted open radical gastrectomy and ERAS perioperative treatment;(4)19 patients in OG group accepted open radical gastrectomy and traditional perioperative treatment.The following clinical indicators were recorded : 1.Preoperative: gender,age,body mass index(BMI),hemoglobin(Hb),white blood cell(WBC),serum albumin(ALB)level,C-reactive protein(CRP),interleukin 6(interleukin 6,IL-6)level 1 day before surgery;2.Intraoperative: record the operation time,intraoperative blood loss and the number of lymph node dissections;3.Postoperative: record the patient 's tumor TMN stage,recovery time of intestinal function,postoperative hospital stay,hospital costs,postoperative discomfort such as nausea and vomiting,complications such as abdominal distension,abdominal pain,incision infection,abdominal cavity and the occurrence of infection and anastomotic leakage.Record and analysis the figure of hemoglobin,white blood cell count,serum albumin,C-reactive protein,IL-6 levels on days 1,3,and 5 after surgery,and the patients' pain scores on days 1,2,and 3 after surgery.4.Follow-up to evaluate the recovery of patients within 30 days after discharge.Result:(1)There was no significant difference between the four groups in gender,age,BMI and tumor TMN stage(P>0.05).(2)Compared with the open surgery group(ERAS+OG group and OG group),the operative time of the laparoscopic group(ERAS+LAG group and LAG group)was significantly longer(P<0.05),and the intraoperative blood loss was significantly reduced(P<0.05).In terms of the number of intraoperative lymph node dissections,there was no statistical difference between the four groups(P>0.05).(3)Hb level during the perioperative period,there was no difference between the four groups 1 day before the operation,and the Hb levels in ERAS groups were higher than the corresponding non-ERAS groups within 5 days after the operation,but the differences were not significant(P>0.05);White blood cell count: There was nothing difference between the 4 groups before the operation(P>0.05).The WBC count in the ERAS+LAG group was lower than that in the LAG group in the 5 days after surgery,and the the WBC count in ERAS+OG group was significantly lower than that in the OG group(P<0.05)in the 5 days after surgery.The WBC count on the 3rd postoperative day in the ERAS+OG group was lower than that in the LAG group(P<0.05).In the ERAS + LAG group,ERAS+OG group,and LAG group,the white blood cell counts returned to the normal range on the 5th postoperative day,while the figure in OG group was still slightly higher than the normal range;IL-6,the differences between each group 1 day before surgery had no statistical significance(P>0.05),IL-6 level in ERAS+LAG group was seemingly lower than LAG group within 5 days after operation,but there was no significant statistical difference(P> 0.05),the IL-6 level of ERAS+OG group in 1,3,5 days after operation was lower than that of OG group(P <0.05),and the level of IL-6 in LAG group was lower than the level in OG group in the same period after surgery(P<0.05).There was no statistically difference in CRP levels in each group 1 day before the surgery(P>0.05).The CRP levels in ERAS group were lower than those in the non-ERAS group at the same period after the operation,but only the difference on the fifth postoperative day was statistically significant(P <0.05)between ERAS+LAG and LAG group,the CRP level of the ERAS+LAG group was significantly lower than the CRP level in OG group(P<0.05);There was no statistical difference of the ALB level between the four groups before surgery(P>0.05).On the first day after surgery,the ALB level in ERA+LAG group and LAG group were higher than the ALB level in the OG group(P<0.05).On the 3rd and 5th day after surgery,the ALB level in the ERAS+LAG group was higher than that in the LAG group,the ALB level in ERAS+OG group was higher than in the OG group,and the ALB level in ERAS+LAG group was higher than in the ERAS+OG group(P<0.05).(4)The time of the first intestinal ventilation after operation in the ERAS+LAG group were shorter than those in the LAG group(P<0.05),and the time in the ERAS+OG group was shorter than that in the OG group(P<0.05);Hospitalization cost of ERAS+LAG group was less than the LAG group,the difference had statistical significance(P<0.05),and the hospitalization cost in ERAS+OG group was less OG group,the difference was statistically significant(P<0.05).The hospitalization cost in ERAS+OG group was the least of the 4 groups(P<0.05);In the four groups,the ERAS+LAG group has the shortest hospital stay and OG group has the longest hospital stay.(5)Within 3 days after surgery,the pain scores of patients using multimodal analgesia in ERAS(ERAS+LAG,ERAS+OG)group were significantly lower than those in the group using the single analgesia model(LAG,OG)(P<0.05).(6)There was no statistical difference in the incidence of postoperative complications among patients in each group(P= 0.598).Conclusions:1.The concept of Enhanced recovery after surgery is currently safe,reliable and effective in the application of radical surgery for gastric cancer.2.The concept of Enhanced recovery after surgery has certain advantages over the traditional perioperative concept in reducing postoperative pain and perioperative stress response.It can also improve the nutritional status of patients,speed up the recovery of digestive tract function,and shorten the length of hospital stay.3.The combination of Enhanced recovery after surgery concept and laparoscopic technology can enable patients to get the best recovery,but there are still some shortcomings in the economic aspect.At present,applying the ERAS concept to open radical gastrectomy seems to be able to relieve the economic pressure of patients,meanwhile ensuring the quality of rehabilitation.