"Fast-track" and "Minimally Invasive" Surgery for Gastric Cancer

被引:18
作者
Liu, Xin-Xin [1 ,2 ]
Pan, Hua-Feng [3 ]
Jiang, Zhi-Wei [1 ]
Zhang, Shu [1 ]
Wang, Zhi-Ming [1 ]
Chen, Ping [2 ]
Zhao, Yan [2 ]
Wang, Gang [1 ]
Zhao, Kun [1 ]
Li, Jie-Shou [1 ]
机构
[1] Nanjing Univ, Sch Med, Jinling Hosp, Dept Gen Surg, Nanjing 210002, Jiangsu, Peoples R China
[2] Yangzhou Univ, Northern Jiangsu Peoples Hosp, Dept Gastrointestinal Surg, Sch Clin Med, Yangzhou 225001, Jiangsu, Peoples R China
[3] Yangzhou Univ, Sch Clin Med, Peoples Hosp Yangzhou 1, Dept Gen Surg, Yangzhou 225001, Jiangsu, Peoples R China
关键词
Enhanced Recovery after Surgery; Fast-track Surgery; Gastrectomy; Minimally Invasive Surgery; Optimized Care; ROBOT-ASSISTED GASTRECTOMY; RANDOMIZED CLINICAL-TRIAL; DISTAL GASTRECTOMY; ENHANCED RECOVERY; COLONIC SURGERY; SURGICAL CARE; HOSPITAL STAY; REHABILITATION; EXPERIENCE; OUTCOMES;
D O I
10.4103/0366-6999.190659
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Enhanced recovery after surgery (ERAS) protocols or fast-track (FT) programs enable a shorter hospital stay and lower complication rate. Minimally invasive surgery (MIS) is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries. However, little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer. The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone. Methods: We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares (SC) or FT programs during January 2004 to December 2014. A total of 984 patients were enrolled and assigned into four groups: open gastrectomies (OG) with SC (OG + SC group, n = 167); OG with FT programs (OG + FT group, n = 277); laparoscopic gastrectomies (LG) with FT programs (LG + FT group, n = 248); and robot-assisted gastrectomies (RG) with FT programs (RG + FT group, n = 292). Patients' data were collected to evaluate the clinical outcome. The primary end point was the length of postoperative hospital stay. Results: The OG + SC group showed the longest postoperative hospital stay (mean: 12.3 days, median: 11 days, interquartile range [IQR]: 6-16 days), while OG + FT, LG + FT, and RG + FT groups recovered faster (mean: 7.4, 6.4, and 6.6 days, median: 6, 6, and 6 days, IQR: 3-9, 4-8, and 3-9 days, respectively, all P < 0.001). The postoperative rehabilitation parameters such as flatus time after surgery (4.7 + 0.9, 3.1 +/- 0.8, 3.0 +/- 0.9, and 3.1 +/- 0.9 days) followed the same manner. After 30 postoperative days' follow-up, the total incidence of complications was 9.6% in OG + SC group, 10.1% in OG + FT group, 8.1% in LG + FT group, and 10.3% in RG + FT group. The complications showed no significant differences between the four groups (all P > 0.05). Conclusions: ERAS protocols alone could significantly bring fast recovery after surgery regardless of the surgical technique. MIS further reduces postoperative hospital stay. It is safe and effective to apply ERAS protocols combined with MIS for gastric cancer.
引用
收藏
页码:2294 / 2300
页数:7
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