Journal Article

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

Pan, Hua-Feng, Jiang, Zhi-Wei, Chen, Ping, Li, Jie-Shou, Wang, Zhi-Ming, Liu, Xin-Xin, Wang, Gang, Zhang, Shu, Zhao, Yan, Zhao, Kun

2016

Overview

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.

• Publisher: Wolters Kluwer - Medknow Publications,Medknow Publications and Media Pvt. Ltd,Lippincott Williams & Wilkins Ovid Technologies,Department of General Surgery%Department of General Surgery, The First People's Hospital of Yangzhou, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu 225001, China%Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China%Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu 225001, China,Medknow Publications & Media Pvt Ltd,Wolters Kluwer
• Subject: Adult / Aged / Care and treatment / Elective Surgical Procedures / Enhanced Recovery after Surgery; Fast-track Surgery; Gastrectomy; Minimally Invasive Surgery; Optimized Care / Female / Gastrectomy / Humans / Laparoscopy / Laparotomy / Length of Stay / Male / Middle Aged / Minimally Invasive Surgical Procedures / Original / Postoperative Care - methods / Postoperative Complications / Retrospective Studies / Risk factors / Stomach cancer / Stomach Neoplasms - surgery / Treatment Outcome