System Evaluation about Application of Enhanced Recovery after Surgery in Radical Resection of Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XUYu-jie , WANGZhen ,  CHENJun-qiang

Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China;

Corresponding?author：

CHENJun-qiang, Email: gxmufh@163.com

Keywords：

Enhanced recovery after surgery; Gastric cancer; Systematic review

DOI：

10.7507/1007-9424.20150112

Video：

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Objective To investigate the safety and feasibility of enhanced recovery after surgery (ERAS) in radical gastrectomy. Methods The Cochrane library, PubMed, EMBASE, and Chinese biomedical literature databases were searched to identify randomized controlled trails including patients undergoing radical gastrectomy surgery who were treated by ERAS or traditional methods.The five outcome variables were the time to passage of first flatus and first defecation, the length of postoperative hospital stay, medical cost, and postoperative complications. Results Fifteen published reports involving 1 533 participants met the inclusion criteria.Compared with traditional methods, ERAS had better outcomes with shorter time to the passage of flatus (WMD=-26.557 hours, 95%CI:-34.097～-19.018, P < 0.05), shorter time to the passage of defecation (WMD=-34.071 hours, 95%CI:-53.449～-14.693, P < 0.05), shorter postoperative hospital stay (WMD=-2.824 days, 95%CI:-3.638～-2.010, P < 0.05), less medical cost (WMD=-0.342 ten thousand yuan, 95%CI:-0.501～-0.184, P < 0.05), and lower postoperative complication rate (RR=0.597, 95%CI: 0.435-0.820, P < 0.05).Especially, ERAS had a significant lower rate of postoperative digestive tract complications (RR=0.492, 95%CI: 0.350-0.693, P < 0.05).However, there were no significant differences between two methods in the incidence of complications including postoperative pulmonary infection, infection or liquefaction of incision, fistula of anastomosis, and postoperative readmission rate (P > 0.05). Conclusions The application of ERAS in the perioperated period of radical gastrectomy surgery shortens the time to passage of first flatus and first defecation, the postoperative hospital stay, as well as lowers the medical cost, and the postoperative complication rate.The results suggest that ERAS is safe and effective in perioperated period of radical gastrectomy and it is very promising in clinical application.

Citation： XUYu-jie, WANGZhen, CHENJun-qiang. System Evaluation about Application of Enhanced Recovery after Surgery in Radical Resection of Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(4): 423-433. doi: 10.7507/1007-9424.20150112 Copy

1.	Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth, 1997, 78(5):606-617.
2.	Slim K.Fast-track surgery:the next revolution in surgical care following laparoscopy.Colorectal Dis, 2011, 13(5):478-480.
3.	Wilmore DW, Kehlet H.Management of patients in fast track surgery.BMJ, 2001, 322(7284):473-476.
4.	Wang G, Jiang Z, Zhao K, et al.Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program.J Gastrointest Surg, 2012, 16(7):1379-1388.
5.	Ionescu D, Iancu C, Ion D, et al.Implementing fast-track protocol for colorectal surgery:a prospective randomized clinical trial.World J Surg, 2009, 33(11):2433-2438.
6.	Varadhan KK, Neal KR, Dejong CH, et al.The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery:a meta-analysis of randomized controlled trials.Clin Nutr, 2010, 29(4):434-440.
7.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al.Enhanced recovery after surgery:a consensus review of clinical care for patients undergoing colonic resection.Clin Nutr, 2005, 24(3):466-477.
8.	Lassen K, Soop M, Nygren J, et al.Consensus review of optimal perioperative care in colorectal surgery:Enhanced Recovery After Surgery (ERAS) Group recommendations.Arch Surg, 2009, 144(10):961-969.
9.	Gustafsson UO, Scott MJ, Schwenk W, et al.Guidelines for perioperative care in elective colonic surgery:Enhanced Recovery After Surgery (ERAS^{^?}) Society recommendations.World J Surg, 2013, 37(2):259-284.
10.	Price TJ, Shapiro JD, Segelov E, et al.Management of advanced gastric cancer.Expert Rev Gastroenterol Hepatol, 2012, 6(2):199-208; quiz 209.
11.	Jemal A, Bray F, Center MM, et al.Global cancer statistics.CA Cancer J Clin, 2011, 61(2):69-90.
12.	Sasako M, Sano T, Yamamoto S, et al.D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer.N Engl J Med, 2008, 359(5):453-462.
13.	Wang DS, Kong Y, Zhong B, et al.Fast-track surgery improves postoperative recovery in patients with gastric cancer:a randomized comparison with conventional postoperative care.J Gastrointest Surg, 2010, 14(4):620-627.
14.	Yamada T, Hayashi T, Cho H, et al.Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery.Gastric Cancer, 2012, 15(1):34-41.
15.	Chen HJ, Xin JL, Cai L, et al.Preliminary experience of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer.J Gastrointest Surg, 2012, 16(10):1830-1839.
16.	Kim JW, Kim WS, Cheong JH, et al.Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer:a randomized clinical trial.World J Surg, 2012, 36(12):2879-2887.
17.	王威.FTS方法干預預防胃癌術后胃乏力癥及改善胃腸道功能指標觀察.中國當代醫藥, 2012, 19(15):183-184.
18.	薛平慧, 劉君, 趙端儀, 等.加速康復外科用于老年胃癌手術患者的價值探討.臨床外科雜志, 2010, 18(3):182-184.
19.	趙玉洲, 韓廣森, 李智, 等.快速康復理念在胃癌圍手術期中的應用.臨床消化病雜志, 2011, 23(1):23-26.
20.	張振彬, 寧進堯, 胡金晨, 等.快速康復外科在腹腔鏡胃癌根治術圍手術期的應用.腹腔鏡外科雜志, 2012, 17(9):671-673.
21.	何志國, 唐云, 吳會國, 等.快速康復外科在胃癌患者圍手術期應用的臨床效果.中華臨床營養雜志, 2010, 18(1):29-32.
22.	唐云, 武現生, 衛勃, 等.快速康復與營養支持在老年胃癌圍手術期聯合應用的臨床效果.中華臨床營養雜志, 2010, 18(3):137-140.
23.	賀健, 李晴, 鄭立君.快通道外科在胃癌根治術中的應用.上海醫學, 2009, 32(8):734-737.
24.	郜永順, 張云飛, 段小偉, 等.胃癌圍手術期快速康復應用研究.腹部外科, 2012, 25(3):152-155.
25.	邱小文, 肖桂珍, 劉惠.早期進食快速康復外科在胃腫瘤手術患者中的應用研究.中國現代醫學雜志, 2012, 22(1):61-64.
26.	孔營, 周巖冰, 王東升, 等.加速康復外科對胃癌手術病人體液免疫和臨床指標的影響.腸外與腸內營養, 2009, 16(4):205-208.
27.	周潮平, 張亞銘, 宋玉慶, 等.快速康復外科在遠端胃癌BillrothⅠ式手術中的臨床應用.安徽醫學, 2011, 32(8):1071-1073.
28.	Feng F, Ji G, Li JP, et al.Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients.World J Gastroenterol, 2013, 19(23):3642-3648.
29.	Liu XX, Jiang ZW, Wang ZM, et al.Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery.JPEN J Parenter Enteral Nutr, 2010, 34(3):313-321.
30.	佟奎明.快速康復外科理念在胃癌圍手術期的應用研究.成都醫學院學報, 2012, B09:88.
31.	姜洪池, 孫備, 王剛.快速康復外科的新理念值得重視.中華外科雜志, 2007, 45(9):577-579.
32.	楊軍蘭, 王滿才, 謝曉峰, 等.快速康復外科應用于胃癌切除術的安全性和可行性的Meta分析.中華消化外科雜志, 2012, 11(5):455-461.
33.	張俊松, 汪宏, 吳立勝, 等.快速康復外科在胃癌根治術中應用療效的系統評論.安徽醫學, 2012, 33(10):1282-1286.
34.	梁冀望, 鄭志超, 趙巖, 等.胃癌根治術應用快速康復外科的系統評價.中國腫瘤, 2012, 21(1):75-80.
35.	Yu Z, Zhuang CL, Ye XZ, et al.Fast-track surgery in gastrectomy for gastric cancer:a systematic review and meta-analysis.Langenbecks Arch Surg, 2014, 399(1):85-92.
36.	王東升, 仲蓓, 孔營, 周巖冰.加速康復外科對胃癌病人術后近期臨床結局的影響.腸外與腸內營養, 2010, 17(6):338-340, 344.

1. Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth, 1997, 78(5):606-617.
2. Slim K.Fast-track surgery:the next revolution in surgical care following laparoscopy.Colorectal Dis, 2011, 13(5):478-480.
3. Wilmore DW, Kehlet H.Management of patients in fast track surgery.BMJ, 2001, 322(7284):473-476.
4. Wang G, Jiang Z, Zhao K, et al.Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program.J Gastrointest Surg, 2012, 16(7):1379-1388.
5. Ionescu D, Iancu C, Ion D, et al.Implementing fast-track protocol for colorectal surgery:a prospective randomized clinical trial.World J Surg, 2009, 33(11):2433-2438.
6. Varadhan KK, Neal KR, Dejong CH, et al.The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery:a meta-analysis of randomized controlled trials.Clin Nutr, 2010, 29(4):434-440.
7. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al.Enhanced recovery after surgery:a consensus review of clinical care for patients undergoing colonic resection.Clin Nutr, 2005, 24(3):466-477.
8. Lassen K, Soop M, Nygren J, et al.Consensus review of optimal perioperative care in colorectal surgery:Enhanced Recovery After Surgery (ERAS) Group recommendations.Arch Surg, 2009, 144(10):961-969.
9. Gustafsson UO, Scott MJ, Schwenk W, et al.Guidelines for perioperative care in elective colonic surgery:Enhanced Recovery After Surgery (ERAS^{^?}) Society recommendations.World J Surg, 2013, 37(2):259-284.
10. Price TJ, Shapiro JD, Segelov E, et al.Management of advanced gastric cancer.Expert Rev Gastroenterol Hepatol, 2012, 6(2):199-208; quiz 209.
11. Jemal A, Bray F, Center MM, et al.Global cancer statistics.CA Cancer J Clin, 2011, 61(2):69-90.
12. Sasako M, Sano T, Yamamoto S, et al.D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer.N Engl J Med, 2008, 359(5):453-462.
13. Wang DS, Kong Y, Zhong B, et al.Fast-track surgery improves postoperative recovery in patients with gastric cancer:a randomized comparison with conventional postoperative care.J Gastrointest Surg, 2010, 14(4):620-627.
14. Yamada T, Hayashi T, Cho H, et al.Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery.Gastric Cancer, 2012, 15(1):34-41.
15. Chen HJ, Xin JL, Cai L, et al.Preliminary experience of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer.J Gastrointest Surg, 2012, 16(10):1830-1839.
16. Kim JW, Kim WS, Cheong JH, et al.Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer:a randomized clinical trial.World J Surg, 2012, 36(12):2879-2887.
17. 王威.FTS方法干預預防胃癌術后胃乏力癥及改善胃腸道功能指標觀察.中國當代醫藥, 2012, 19(15):183-184.
18. 薛平慧, 劉君, 趙端儀, 等.加速康復外科用于老年胃癌手術患者的價值探討.臨床外科雜志, 2010, 18(3):182-184.
19. 趙玉洲, 韓廣森, 李智, 等.快速康復理念在胃癌圍手術期中的應用.臨床消化病雜志, 2011, 23(1):23-26.
20. 張振彬, 寧進堯, 胡金晨, 等.快速康復外科在腹腔鏡胃癌根治術圍手術期的應用.腹腔鏡外科雜志, 2012, 17(9):671-673.
21. 何志國, 唐云, 吳會國, 等.快速康復外科在胃癌患者圍手術期應用的臨床效果.中華臨床營養雜志, 2010, 18(1):29-32.
22. 唐云, 武現生, 衛勃, 等.快速康復與營養支持在老年胃癌圍手術期聯合應用的臨床效果.中華臨床營養雜志, 2010, 18(3):137-140.
23. 賀健, 李晴, 鄭立君.快通道外科在胃癌根治術中的應用.上海醫學, 2009, 32(8):734-737.
24. 郜永順, 張云飛, 段小偉, 等.胃癌圍手術期快速康復應用研究.腹部外科, 2012, 25(3):152-155.
25. 邱小文, 肖桂珍, 劉惠.早期進食快速康復外科在胃腫瘤手術患者中的應用研究.中國現代醫學雜志, 2012, 22(1):61-64.
26. 孔營, 周巖冰, 王東升, 等.加速康復外科對胃癌手術病人體液免疫和臨床指標的影響.腸外與腸內營養, 2009, 16(4):205-208.
27. 周潮平, 張亞銘, 宋玉慶, 等.快速康復外科在遠端胃癌BillrothⅠ式手術中的臨床應用.安徽醫學, 2011, 32(8):1071-1073.
28. Feng F, Ji G, Li JP, et al.Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients.World J Gastroenterol, 2013, 19(23):3642-3648.
29. Liu XX, Jiang ZW, Wang ZM, et al.Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery.JPEN J Parenter Enteral Nutr, 2010, 34(3):313-321.
30. 佟奎明.快速康復外科理念在胃癌圍手術期的應用研究.成都醫學院學報, 2012, B09:88.
31. 姜洪池, 孫備, 王剛.快速康復外科的新理念值得重視.中華外科雜志, 2007, 45(9):577-579.
32. 楊軍蘭, 王滿才, 謝曉峰, 等.快速康復外科應用于胃癌切除術的安全性和可行性的Meta分析.中華消化外科雜志, 2012, 11(5):455-461.
33. 張俊松, 汪宏, 吳立勝, 等.快速康復外科在胃癌根治術中應用療效的系統評論.安徽醫學, 2012, 33(10):1282-1286.
34. 梁冀望, 鄭志超, 趙巖, 等.胃癌根治術應用快速康復外科的系統評價.中國腫瘤, 2012, 21(1):75-80.
35. Yu Z, Zhuang CL, Ye XZ, et al.Fast-track surgery in gastrectomy for gastric cancer:a systematic review and meta-analysis.Langenbecks Arch Surg, 2014, 399(1):85-92.
36. 王東升, 仲蓓, 孔營, 周巖冰.加速康復外科對胃癌病人術后近期臨床結局的影響.腸外與腸內營養, 2010, 17(6):338-340, 344.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

System Evaluation about Application of Enhanced Recovery after Surgery in Radical Resection of Gastric Cancer

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