Published online Jan 28, 2018. doi: 10.3748/wjg.v24.i4.504
Peer-review started: November 29, 2017
First decision: December 13, 2017
Revised: January 1, 2018
Accepted: January 1, 2018
Article in press: January 1, 2018
Published online: January 28, 2018
Processing time: 58 Days and 0.9 Hours
For gastric cancer, uncut Roux-en-Y gastrojejunostomy after distal gastrectomy is still the most important treatment. However, the safety of enhanced recovery after surgery (ERAS) protocol for gastric surgery is not clear.
Only a few studies have focused on the use of the perioperative ERAS program for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy. It is unclear whether introduction of the ERAS concept benefits the Chinese population.
This study aimed to evaluate the safety and feasibility of ERAS for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy. We can use the ERAS protocol for these patients to reduce the duration of the hospital stay and improve the degree of comfort and satisfaction of patients.
The clinical data of 42 patients who were divided into a control group of 22 patients and an ERAS group of 20 patients were collected. The observed indicators included operation conditions, postoperative clinical indexes, and postoperative serum stress indexes. Measurement data following a normal distribution are presented as mean ± SD and were analyzed by t-test. Count data were analyzed by chi-squared test.
The operative time, volume of intraoperative blood loss, and number of patients with conversion to open surgery were not significantly different between the two groups. Postoperative clinical indexes, including the time to initial anal exhaust, time to initial liquid diet intake, time to out-of-bed activity, and duration of hospital stay of patients without complications, were significantly different between the two groups. However, the time to initial defecation, time to abdominal drainage-tube removal, and the early postoperative complications were not significantly different between the two groups. Regarding postoperative complications, on the first and the third days after the operation, the white blood cell count and C reactive protein and interleukin-6 levels in the ERAS group were significantly lower than those in the control group.
We found that the perioperative ERAS program for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy is safe and effective and should be popularized. In this study, we carried out long-term follow-up and prognosis analysis of patients with gastric cancer who received uncut Roux-en-Y gastrojejunostomy after distal gastrectomy at our center to provide a theoretical basis for prognosis improvement of the patients.
From this study, we can find that ERAS can be used not only for herniorrhaphy, gastrointestinal surgery, gynecologic operations, and other applications, but also for gastric surgery. The direction of the future research is that an effective perioperative management program specific for gastric cancer is needed to be developed. The best method is to conduct a large-scale clinical trial to verify it.