Fast track surgery in laparoscopy-assisted radical distal gastrectomy

/Hu Jinchen

(胡金晨，Dept Gen Surg，Qilu Hosp Shandong Univ，Jinan 250012)…∥Chin J Gen Surg.-2011，14(8).-837 ～840

ObjectiveTo evaluate the safety and effectiveness of fast track surgery(FTS)in laparoscopy-assisted radical distal gastrectomy(LADG)for gastric cancer.MethodsSixty-one patients with distal gastric cancer were randomly divided into three groups:FTS+LADG group(n=19)undergoing LADG and FTS treatments，LADG group(n=22)undergoing LADG and traditional perioperatve cares，and FTS+ODG(open distal gastrectomy)group(n=21)undergoing ODG and FTS treatments.FTS treatments included avoidance of mechanical bowel cleansing，restrictive perioperative intravenous infusion，early ambulation，early enteral nutrition.The age，sex，body weight，anastomtic mode，number of lymph node dissected，and tumor stage，serum albumn(ALB)，blood urea nitrogen(BUN)，C-reaction protein(CRP)，flatus time，postoperative hospital stay，medical cost，and postoperative complications were compared between three groups.ResultsThe level of ALB in FTS+LADG group was higher than in LADG group at the 4th and 7th day after surgery(P ＜ 0.05，P ＜ 0.01).Compared to LADG group，the variation of ALB from preoperation to 4th day after surgery in FTS+LADG group and FTS+ODG group was significant(P ＜ 0.01，P ＜ 0.05).CRP level between FTS+LADG group and FTS+ODG group was different significantly at 4th and 7th day after surgery(P＜0.05，P ＜ 0.05).FTS+LADG group has earlier recovery of gastrointestinal peristalsis than other two groups(P ＜0.05，P ＜0.05).The medical cost in FTS+LADG group was less than that in LADG group(P=0.003)，but higher than in FTS+ODG group(P ＜ 0.01).ConclusionThe practice of FTS in LADG was safe，effective，it improves nutritional status，eases stress reaction，accelerates gastrointestinal perstalsis and postoperative rehabilitaion.6 refs，4 tabs.