Top

Published in:

01-10-2012 | Original Article

Preliminary Experience of Fast-Track Surgery Combined with Laparoscopy-Assisted Radical Distal Gastrectomy for Gastric Cancer

Authors: Jin chen Hu, Li xin Jiang, Li Cai, Hai tao Zheng, San yuan Hu, Hong bing Chen, Guo chang Wu, Yi fei Zhang, Zhong chuan Lv

Published in: Journal of Gastrointestinal Surgery | Issue 10/2012

Abstract

Objective

The aim of this study was to evaluate the safety and effectiveness of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer.

Methods

Eighty-eight eligible patients were randomly assigned into four groups: (1) fast-track surgery (FTS) + laparoscopy-assisted radical distal gastrectomy (LADG), treated with LADG and FTS treatment; (2) LADG, treated with LADG and traditional treatment; (3) FTS + open distal grastectomy (ODG), treated with ODG and FTS treatment; and (4) ODG, treated with ODG and traditional treatment. The clinical parameters and serum indicators were compared.

Results

Compared with the ODG group, the other three groups had earlier first flatus and shorter postoperative hospital stay (all P <0.01; all P <0.05), especially in the FTS + LADG group. The level of ALB was higher in the FTS + LADG group than in the LADG group at 4 and 7 days after surgery (P <0.05, P <0.01). The level of CRP in the FTS + LADG group was lower than in the FTS+ODG group at 4 and 7 days after surgery (P <0.05, P <0.05). The FTS + ODG group had lowest medical costs.

Conclusion

Combination of FTS and LADG in gastric cancer is safe, feasible, and efficient and can improve nutritional status, lessen postoperative stress, and accelerate postoperative rehabilitation. Compared with FTS + ODG and LADG, its advantages were limited in short-term follow-up.

Hubner M, Muller S, Bonnard L, Givel JC, Demartines N: Fast track surgery. Rev Med Suisse 2008;4:2001–2004.PubMed

Hasenberg T, Langle F, Reibenwein B, Schindler K, Post S, Spies C, Schwenk W, Shang E: Current perioperative practice in rectal surgery in Austria and Germany. Int J Colorectal Dis 2010; 5(7):855–863CrossRef

Counihan TC, Favuzza J: Fast track colorectal surgery. Clin Colon Rectal Surg 2009;22:60–72.PubMedCrossRef

Wang D, Kong Y, Zhong B, Zhou X, Zhou Y: Fast-track surgery improves postoperative recovery in patients with gastric cancer: A randomized comparison with conventional postoperative care. J Gastrointest Surg 2010;14:620–627.PubMedCrossRef

Koea JB, Young Y, Gunn K: Fast track liver resection: The effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia. HPB Surg 2009;2009:271986.PubMedCrossRef

Ionescu D, Iancu C, Ion D, Al-Hajjar N, Margarit S, Mocan L, Mocan T, Deac D, Bodea R, Vasian H: Implementing fast-track protocol for colorectal surgery: A prospective randomized clinical trial. World J Surg 2009;33:2433–2438.PubMedCrossRef

Holm B, Kristensen MT, Myhrmann L, Husted H, Andersen LO, Kristensen B, Kehlet H: The role of pain for early rehabilitation in fast track total knee arthroplasty. Disabil Rehabil 2010;32:300–306.PubMedCrossRef

Andersen LO, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H: Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 2009;64:508–513.PubMedCrossRef

Pruthi RS, Nielsen M, Smith A, Nix J, Schultz H, Wallen EM: Fast track program in patients undergoing radical cystectomy: Results in 362 consecutive patients. J Am Coll Surg 2010;210:93–99.PubMedCrossRef

10.

Chughtai B, Abraham C, Finn D, Rosenberg S, Yarlagadda B, Perrotti M: Fast track open partial nephrectomy: Reduced postoperative length of stay with a goal-directed pathway does not compromise outcome. Adv Urol 2008; doi:10.1155/2008/507543, 507543

11.

Kroon UB, Radstrom M, Hjelthe C, Dahlin C, Kroon L: Fast-track hysterectomy: A randomised, controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151(2):203–207PubMedCrossRef

12.

Lohr G, Keller H, Kutscher J, Huber R: [fast-track rehabilitation after open aorto-iliac vascular procedures]. Zentralbl Chir 2008;133:344–348.PubMedCrossRef

13.

Barletta JF, Miedema SL, Wiseman D, Heiser JC, McAllen KJ: Impact of dexmedetomidine on analgesic requirements in patients after cardiac surgery in a fast-track recovery room setting. Pharmacotherapy 2009;29:1427–1432.PubMedCrossRef

14.

Struber M, Winterhalter M: [fast track in cardiac surgery]. Chirurg 2009;80:724–729.PubMedCrossRef

15.

French JJ, Mansfield SD, Jaques K, Jaques BC, Manas DM, Charnley RM: Fast-track management of patients undergoing proximal pancreatic resection. Ann R Coll Surg Engl 2009;91:201–204.PubMedCrossRef

16.

Muhling B, Orend KH, Sunder-Plassmann L: [fast track in thoracic surgery]. Chirurg 2009;80:706–710.PubMedCrossRef

17.

Das-Neves-Pereira JC, Bagan P, Coimbra-Israel AP, Grimaillof-Junior A, Cesar-Lopez G, Milanez-de-Campos JR, Riquet M, Biscegli-Jatene F: Fast-track rehabilitation for lung cancer lobectomy: A five-year experience. Eur J Cardiothorac Surg 2009;36:383–391; discussion 391–382.PubMedCrossRef

18.

Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND: Stress response to laparoscopic surgery: A review. Surg Endosc 2004;18:1022–1028.PubMedCrossRef

19.

Yu G, Tang B, Yu PW, Peng ZH, Qian F, Sun G: Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc 2010;24:2860–2870.PubMedCrossRef

20.

Kawamura H, Yokota R, Homma S, Kondo Y: Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy. Surg Endosc 2010; 24(11):2739–2742PubMedCrossRef

21.

Wind J, Hofland J, Preckel B, Hollmann MW, Bossuyt PM, Gouma DJ, van Berge Henegouwen MI, Fuhring JW, Dejong CH, van Dam RM, Cuesta MA, Noordhuis A, de Jong D, van Zalingen E, Engel AF, Goei TH, de Stoppelaar IE, van Tets WF, van Wagensveld BA, Swart A, van den Elsen MJ, Gerhards MF, de Wit LT, Siepel MA, van Geloven AA, Juttmann JW, Clevers W, Bemelman WA: Perioperative strategy in colonic surgery; laparoscopy and/or fast track multimodal management versus standard care (lafa trial). BMC Surg 2006;6:16.PubMedCrossRef

22.

Weimann G, Lev E: Mass-mediated medicine. Isr Med Assoc J 2006;8:757–762.PubMed

23.

Aikou T, Hokita S, Natsugoe S: [japanese classification of gastric carcinoma (the 13th edition, June 1999): Points to be revised]. Nippon Rinsho 2001;59 Suppl 4:159–165.PubMed

24.

Dindo D, Demartines N, Clavien PA: Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.PubMedCrossRef

25.

Lee JH, Park DJ, Kim HH, Lee HJ, Yang HK: Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien–Dindo classification. Surg Endosc 2011; 26(5):1287–1295. doi:10.1007/s00464-011-2027-0 PubMedCrossRef

26.

Wilmore DW, Kehlet H: Management of patients in fast track surgery. BMJ 2001;322:473–476.PubMedCrossRef

27.

Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630–641.PubMedCrossRef

28.

Jiang ZW, Li JS, Wang ZM, Li N, Liu XX, Li WY, Zhu SH, Diao YQ, Nai YJ, Huang XJ: The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy. Zhonghua Wai Ke Za Zhi 2007;45:1314–1317.PubMed

29.

Nishiguchi K, Okuda J, Toyoda M, Tanaka K, Tanigawa N: Comparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma. Dis Colon Rectum 2001;44:223–230.PubMedCrossRef

30.

31.

Lee JH, Yom CK, Han HS: Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 2009;23:1759–1763.PubMedCrossRef

32.

Etoh T, Shiraishi N, Kitano S: Laparoscopic gastrectomy for cancer. Dig Dis 2005;23:113–118.PubMedCrossRef

33.

Grantcharov TP, Kehlet H: Laparoscopic gastric surgery in an enhanced recovery programme. Br J Surg 2010;97:1547–1551.PubMedCrossRef

34.

Lee JH, Han HS: A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: Early results. Surg Endosc 2005;19:168–173.PubMedCrossRef

35.

Henriksen MG, Jensen MB, Hansen HV, Jespersen TW, Hessov I: Enforced mobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery. Nutrition 2002;18:147–152.PubMedCrossRef

36.

Fukuzawa J, Terashima H, Ohkohchi N: Early postoperative oral feeding accelerates upper gastrointestinal anastomotic healing in the rat model. World J Surg 2007;31:1234–1239.PubMedCrossRef

37.

Hou H, Ping X, Zhu Y, Zhao Z, Li Y, Li J: Dietary fiber alleviates intestinal barrier dysfunction in post-trauma rats. Clin Invest Med 2010;33:E117.PubMed

38.

Sagar PM, Holdsworth PJ, Godwin PG, Quirke P, Smith AN, Johnston D (1992) Comparison of triplicated (s) and quadruplicated (w) pelvic ileal reservoirs. Studies on manovolumetry, fecal bacteriology, fecal volatile fatty acids, mucosal morphology, and functional results. Gastroenterology 102:520–528.PubMed

39.

Nelson R, Tse B, Edwards S: Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005;92:673–680.PubMedCrossRef

40.

Livingston EH, Passaro EP, Jr.: Postoperative ileus. Dig Dis Sci 1990;35:121–132.PubMedCrossRef

41.

Lewis SJ, Andersen HK, Thomas S: Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: A systematic review and meta-analysis. J Gastrointest Surg 2009;13:569–575.PubMedCrossRef

Title: Preliminary Experience of Fast-Track Surgery Combined with Laparoscopy-Assisted Radical Distal Gastrectomy for Gastric Cancer
Authors: Jin chen Hu
Li xin Jiang
Li Cai
Hai tao Zheng
San yuan Hu
Hong bing Chen
Guo chang Wu
Yi fei Zhang
Zhong chuan Lv
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1969-4

At a glance: The STEP trials

Springer Medicine

Preliminary Experience of Fast-Track Surgery Combined with Laparoscopy-Assisted Radical Distal Gastrectomy for Gastric Cancer

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2012

Concurrent Chemoradiotherapy Followed by Metastasectomy Converts to Survival Benefit in Stage IV Rectum Cancer

Management of Squamous Cell Cancer of the Oesophagus in a Patient with a Polyglandular Endocrinopathy (APECED) and Achalasia

Extramammary Paget Disease in Peristomal Skin: Report of a Unique Case

Diaphragmatic Hernia After Hepatic Resection: Case Series at a Single Western Institution

Acute Appendicitis in Patients with End-Stage Renal Disease

Systematic Review and Meta-analysis of the Influence of HER2 Expression and Amplification in Operable Oesophageal Cancer