Clinical Trials Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2018; 24(4): 504-510
Published online Jan 28, 2018. doi: 10.3748/wjg.v24.i4.504
Application value of enhanced recovery after surgery for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy
Yi-Feng Zang, Feng-Zhou Li, Zhi-Peng Ji, Yin-Lu Ding
Yi-Feng Zang, Feng-Zhou Li, Zhi-Peng Ji, Yin-Lu Ding, Department of General Surgery, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
Author contributions: Zang YF and Li FZ designed the research and analyzed the data; Zang YF drafted the manuscript; Ji ZP provided clinical advice; Zang YF and Ding YL revised the paper and Ding YL approved the final version.
Supported by Jinan Science&Technology Bureau, No. 201704125.
Institutional review board statement: The study was reviewed and approved by the Second Hospital of Shandong University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yin-Lu Ding, MD, Chief Doctor, Department of General Surgery, The Second Hospital of Shandong University, 247#, Beiyuan Street, Jinan 250033, Shandong Province, China. dingyinlu123@sina.com
Telephone: +86-15153169369 Fax: +86-531-85875561
Received: November 29, 2017
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.