“Fast track” rehabilitation after gastric cancer resection: experience with 80 consecutive cases

BMC Gastroenterology

Lie Wang¹  Li-ying Lin¹  Zai-zhong Zhang¹  Chen Lin¹  Bing Wang¹  Xiao-huang Tu¹  Jing-xiang Song¹ 

[1] Department of General Surgery, Fuzhou General Hospital of Nanjing Military Command, No. 156 North Xi’erhuan Road, Fuzhou 350025, Fujian, China

关键词: Morbidity;    Hospital stay;    Perioperative treatment;    Fast-track surgery;    Gastric cancer;   

Others  :  1121839
DOI  :  10.1186/1471-230X-14-147

 received in 2013-12-31, accepted in 2014-08-08,  发布年份 2014

【 摘 要 】

Background

To evaluate the safety, efficacy and outcomes of fast-track rehabilitation applied to gastric cancer proximal, distal and total gastrectomy.

Methods

Eighty consecutive patients undergoing gastric cancer resection performed by a single surgeon, received perioperative multimodal rehabilitation. Demographic and operative data, gastrointestinal function, postoperative hospital stays, surgical and general complications and mortality were assessed prospectively.

Results

Of the 80 patients (mean age 56.3 years), 10 (12.5%) received proximal subtotal gastrectomy (Billroth I), 38 (47.5%) received distal (Billroth II), and 32 (40%) received total gastrectomy (Roux-en-Y). Mean operative time was 104.9 minutes and intraoperative blood loss was 281.9 ml. Time to first flatus was 2.8 ± 0.5 postoperative days. Patients were discharged at a mean of 5.3 ± 2.2 postoperative days; 30-day readmission rate was 3.8%. In-hospital mortality was 0%; general and surgical complications were both 5%.

Conclusions

Fast-track multimodal rehabilitation is feasible and safe in patients undergoing gastric cancer resection and may reduce time to first flatus and postoperative hospital stays.

【 授权许可】

   
2014 Song et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Cancer IAfRo: Cancer Fact Sheet: Stomach Cancer Incidence and Mortality Worldwide IARC GLOBOCAN. 2012. [cited 2013 August 18] Available from: http://globocan.iarc.fr/old/FactSheets/cancers/stomach-new.asp webcite
• [2]Degiuli M, Sasako M, Ponti A, Soldati T, Danese F, Calvo F: Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol 1998, 16:1490-1493.
• [3]Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P: Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial: the Surgical Cooperative Group. Lancet 1996, 347:995-999.
• [4]Feng F, Ji G, Li JP, Li XH, Shi H, Zhao ZW, Wu GS, Liu XN, Zhao QC: Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients. World J Gastroenterol 2013, 19:3642-3648.
• [5]Mocan L, Tomus C, Bartos D, Zaharie F, Ioana I, Bartos A, Puia C, Necula A, Mocan T, Iancu C: Long term outcome following surgical treatment for distal gastric cancer. J Gastrointestin Liver Dis 2013, 22:53-58.
• [6]Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J: Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg 2004, 91:283-287.
• [7]Sierra A, Regueira FM, Hernandez-Lizoain JL, Pardo F, Martinez-Gonzalez MA, A-Cienfuegos J: Role of the extended lymphadenectomy in gastric cancer surgery: experience in a single institution. Ann Surg Oncol 2003, 10:219-226.
• [8]Portanova M, Vargas F, Lombardi E, Mena V, Carbajal R, Palacios N, Orrego J: Results of specialization in the surgical treatment of gastric cancer in Peru. Gastric Cancer 2007, 10:92-97.
• [9]Biffi R, Chiappa A, Luca F, Pozzi S, Lo Faso F, Cenciarelli S, Andreoni B: Extended lymph node dissection without routine spleno-pancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients. J Surg Oncol 2006, 93:394-400.
• [10]Isguder AS, Nazli O, Tansug T, Bozdag AD, Onal MA: Total gastrectomy for gastric carcinoma. Hepatogastroenterology 2005, 52:302-304.
• [11]Kitano S, Iso Y, Moriyama M, Sugimachi K: Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994, 4:146-148.
• [12]Wang W, Chen K, Xu XW, Pan Y, Mou YP: Case-matched comparison of laparoscopy-assisted and open distal gastrectomy for gastric cancer. World J Gastroenterol 2013, 19:3672-3677.
• [13]Danielson H, Kokkola A, Kiviluoto T, Sirén J, Louhimo J, Kivilaakso E, Puolakkainen P: Clinical outcome after D1 vs D2-3 gastrectomy for treatment of gastric cancer. Scand J Surg 2007, 96:35-40.
• [14]Marrelli D, Pedrazzani C, Neri A, Corso G, DeStefano A, Pinto E, Roviello F, Marrelli D, Pedrazzani C, Neri A, Corso G, DeStefano A, Pinto E, Roviello F: Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol 2007, 14:25-33.
• [15]Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg 2002, 183:630-641.
• [16]Kehlet H, Dahl JB: Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003, 362:1921-1928.
• [17]Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H: A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000, 232:51-57.
• [18]Basse L, Jacobsen DH, Billesbolle P, Kehlet H: Colostomy closure after Hartmann’s procedure with fast-track rehabilitation. Dis Colon Rectum 2002, 45:1661-1664.
• [19]Basse L, Jakobsen DH, Bardram L, Billesbølle P, Lund C, Mogensen T, Rosenberg J, Kehlet H: Functional recovery after open versus laparoscopic colonic resection. Ann Surg 2005, 241:416-423.
• [20]Teeuwen PH, Bleichrodt RP, de Jong PJ, van Goor H, Bremers AJ: Enhanced recovery after surgery versus conventional perioperative care in rectal surgery. Dis Colon Rectum 2011, 54:833-839.
• [21]Yang D, He W, Zhang S, Chen H, Zhang C, He Y: Fast-track surgery improves postoperative clinical recovery and immunity after elective surgery for colorectal carcinoma: randomized controlled clinical trial. World J Surg 2012, 36:1874-1880.
• [22]Fierens J, Wolthuis AM, Penninckx F, D’Hoore A: Enhanced recovery after surgery (ERAS) protocol: prospective study of outcome in colorectal surgery. Acta Chir Belg 2012, 112:355-358.
• [23]Yang DJ, He WL, Zhang S, Chen HY, Huang WQ, Cai SR, Chen CQ, Ma JP, Zhang CH, He YL, Zhan WH: Fast track surgery accelerates the postoperative rehabilitation and recovery of insulin sensitivity in elective operation for colorectal carcinoma: a randomized controlled clinical trial. Zhonghua Wai Ke Za Zhi 2012, 50:870-874.
• [24]Muehling BM, Ortlieb L, Oberhuber A, Orend KH: Fast track management reduces the systemic inflammatory response and organ failure following elective infrarenal aortic aneurysm repair. Interact Cardiovasc Thorac Surg 2011, 12:784-788.
• [25]Chen QY, Huang CM, Lin JX, Zheng CH, Li P, Xie JW, Wang JB, Lu J: Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer with serosal invasion: a case control study. World J Surg Oncol 2012, 10:248.
• [26]Chun HT, Kim KH, Kim MC, Jung GJ: Comparative study of laparoscopic-assisted versus open subtotal gastrectomy for pT2 gastric cancer. Yonsei Med J 2012, 53:952-959.
• [27]Cui M, Xing JD, Yang W, Ma YY, Yao ZD, Zhang N, Su XQ: D2 dissection in laparoscopic and open gastrectomy for gastric cancer. World J Gastroenterol 2012, 18:833-839.
• [28]Lin JX, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lu J: Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China. World J Surg Oncol 2013, 11:4.
• [29]Holte K, Kehlet H: Postoperative ileus: a preventable event. Br J Surg 2000, 87:1480-1493.
• [30]Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F: Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc 2007, 21:247-252.
• [31]Steinbrook RA: Epidural anesthesia and gastrointestinal motility. Anesth Analg 1998, 86:837-844.
• [32]Gendall KA, Kennedy RR, Watson AJ, Frizelle FA: The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Dis 2007, 9:584-598. discussion 598–600
• [33]Bisgaard T, Kehlet H: Early oral feeding after elective abdominal surgery–what are the issues? Nutrition 2002, 18:944-948.
• [34]Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW: Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 2003, 46:851-859.
• [35]Kim MC, Jung GJ, Kim HH: Morbidity and mortality of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Dig Dis Sci 2007, 52:543-548.
• [36]Schwenk W, Neudecker J, Raue W, Haase O, Muller JM: “Fast-track” rehabilitation after rectal cancer resection. Int J Colorectal Dis 2006, 21:547-553.
• [37]Jakobsen DH, Sonne E, Andreasen J, Kehlet H: Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis 2006, 8:683-687.
• [38]Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ: Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 2003, 90:1497-1504.
• [39]Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA: Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 2007, 24:441-449.
• [40]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.
• [41]Kim JW, Kim WS, Cheong JH, Hyung WJ, Choi SH, Noh SH: Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg 2012, 36:2879-2887.
• [42]Chen HJ, Xin JL, Cai L, Tao ZH, Yuan HS, Fing CH, Chang WG, Fei ZY, Chuan LZ: Preliminary experience of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer. J Gastrointest Surg 2012, 16:10.
• [43]Grantcharov TP, Kehlet H: Laparoscopic gastric surgery in an enhanced recovery programme. Br J Surg 2010, 97:1547-1551.
• [44]Doglietto GB, Pacelli F, Papa V, Tortorelli AP, Bossola M, Covino M, Italian Total Gastrectomy Study Group Members: Use of a nasojejunal tube after total gastrectomy: a multicentre prospective randomised trial. Chir Ital 2004, 56:761-768.
• [45]Yoo CH, Son BH, Han WK, Pae WK: Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg 2002, 168:379-383.
• [46]Doglietto GB, Papa V, Tortorelli AP, Bossola M, Covino M, Pacelli F, Italian Total Gastrectomy Study Group: Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial. Arch Surg 2004, 139:1309-1313. discussion 1313
• [47]Carrere N, Seulin P, Julio CH, Bloom E, Gouzi JL, Pradere B: Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg 2007, 31:122-127.
• [48]Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF: Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 2001, 234:487-493. discussion 493–494
• [49]Kumar M, Yang SB, Jaiswal VK, Shah JN, Shreshtha M, Gongal R: Is prophylactic placement of drains necessary after subtotal gastrectomy? World J Gastroenterol 2007, 13:3738-3741.
• [50]Alvarez Uslar R, Molina H, Torres O, Cancino A: Total gastrectomy with or without abdominal drains. A prospective randomized trial. Rev Esp Enferm Dig 2005, 97:562-569.
• [51]Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD: Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 2003, 238:161-167.