ABSTRACT
Objective:To explore the safety and feasibility of the concept of enhanced recovery after surgery in the removal of catheters at different stages after laparoscopic gastric cancer surgery.Methods:A total of 219 patients who underwent laparoscopic radical gastrectomy in Harbin Medical University Cancer Hospital from December 2017 to January 2019 were selected as the research subjects. All patients were divided into groups A, B, and C according to the random number table with 73 cases each. One case in each group fell off, and 72 cases in each group finished the study. In group A, the ureter was removed 12 hours after operation; in group B, the ureter was removed 24 hours after operation; in group C, the ureter was removed 48 hours after operation. The urination-related indicators and rehabilitation indicators among the three groups of patients were compared.Results:There was no significant difference in the number of cases of urinary urination, the number of urinary retention and reinsertion cases, the number of urinary tract irritation, the number of urinary routine abnormalities, and the urination pain score after the first urinary extubation ( P> 0.05). The patients in group A got out of bed activity time, first ventilation time, postoperative hospital stays, total hospital stays, total hospitalization costs were (10.26 ± 4.51) h, (28.74 ± 8.04) h, (4.94 ± 1.73) d, (6.68 ± 1.93) d, (7.19 ± 0.31) ten thousand yuan, group B were (16.37 ± 5.13) h, (39.16 ± 11.52) h, (5.27 ± 1.97) d, (7.83 ± 1.88) d, (7.51 ± 0.36) ten thousand yuan, and group C were (24.19 ± 5.77) h, (54.37 ± 17.49) h, (6.48 ± 1.73) d, (8.16 ± 1.81) d, (7.98 ±0.42) ten thousand yuan. There were statistically significant differences among the three groups ( F values were 12.376 - 131.721, all P <0.01). Conclusions:It is safe and feasible to remove the catheter early after laparoscopic gastric cancer surgery under the concept of enhanced recovery after surgery. It can promote the early recovery of patients, reduce hospitalization time and reduce the overall economic burden of patients.
ABSTRACT
Primary lesion removal and lymph node dissection are the main constituents of radical gastrectomy. However, the high recurrence rate after D2 radical gastrectomy for advanced gastric cancer has not improved. Recently, studies have found that discrete tumor deposits in the mesogastrium may be an important factor affecting the prognosis of gastric cancer after surgery. With the development of laparoscopic equipment, the ever-expanding "submicroscopic vision" makes it possible to completely remove the mesogastrium. Professor Gong Jianping advocated "membrane anatomy" to optimize the concept of radical gastrectomy: D2- based complete mesenteric resection (CME), namely D2+CME procedure. To prevent the leakage of tumor cells into the surgical field, as histological barrier, the intact mesogastrium should be located. The essential difference between D2+CME and previous D2/D2+systematic mesogastrium excision (SME), en-bloc mesogastric excision (EME) is as follow: double-factor guiding (lymph nodes and discrete tumor deposits) vs. single factor guiding (lymph nodes only). After practicing dozens of radical gastrectomy (D2+CME) authors believe that its conceptual connotation (double factor guiding) and operational extension (above mesentery bed) cover D2. In D2+CME surgery, depending on the anatomical identification under the magnified field of view, the conformal space between gastric mesentery and mesenteric beds is unique operational plane with repeatability. These findings and considerations address one problem: where is the precise boundary of en bloc principle in radical gastrectomy? In author′s opinion, with laparoscopy and "sub-microsurgery" progression and detection of discrete tumor deposit metastasis, survival benefit from definition of en bloc boundary in radical gastrectomy will be widely recognized. Meanwhile, D2+CME procedure is an appropriate way for study. Although the development of the "membrane anatomy" concept for gastric cancer still requires many further clinical and basic researches, it is reasonable to foresee that D2+CME surgery will guide a concept-optimized era for gastric cancer surgery.
ABSTRACT
Objective: To investigate the clinical effect of ω-3 polyunsaturated fatty acids (ω-3 PUFA) on elder patients after gastric cancer radical operation. Methods: Forty patients were randomly divided into experimental group (EG) and control group(CG). The patients of CG were treated with hypocaloric and lower nitrogen parenteral nutrition, and those in EG received ω-3 PUFA additionally. The nutrition index, immune function, liver function, inflammatory reaction and complications were compared. Results: The rate of complications significantly decreased in the EG (20% vs 5% , χ~2 = 3. 958, P 0. 05). The level of prealbumin was significantly increased in the EG. The humoral immunity and cellular immunity were higher in the EG than those in the CG. IL-6, TNF-α and CRP levels on postoperative d5 were significantly depressed in the EG. Conclusion: Postoperative supplementation of ω-3 PUFA may have a favorable effect on the outcomes in elder gastric cancer patients.