Skip to main content
SpringerLink
Log in

Preliminary Experience of Fast-Track Surgery Combined with Laparoscopy-Assisted Radical Distal Gastrectomy for Gastric Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

The aim of this study was to evaluate the safety and effectiveness of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer.

Methods

Eighty-eight eligible patients were randomly assigned into four groups: (1) fast-track surgery (FTS) + laparoscopy-assisted radical distal gastrectomy (LADG), treated with LADG and FTS treatment; (2) LADG, treated with LADG and traditional treatment; (3) FTS + open distal grastectomy (ODG), treated with ODG and FTS treatment; and (4) ODG, treated with ODG and traditional treatment. The clinical parameters and serum indicators were compared.

Results

Compared with the ODG group, the other three groups had earlier first flatus and shorter postoperative hospital stay (all P <0.01; all P <0.05), especially in the FTS + LADG group. The level of ALB was higher in the FTS + LADG group than in the LADG group at 4 and 7 days after surgery (P <0.05, P <0.01). The level of CRP in the FTS + LADG group was lower than in the FTS+ODG group at 4 and 7 days after surgery (P <0.05, P <0.05). The FTS + ODG group had lowest medical costs.

Conclusion

Combination of FTS and LADG in gastric cancer is safe, feasible, and efficient and can improve nutritional status, lessen postoperative stress, and accelerate postoperative rehabilitation. Compared with FTS + ODG and LADG, its advantages were limited in short-term follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hubner M, Muller S, Bonnard L, Givel JC, Demartines N: Fast track surgery. Rev Med Suisse 2008;4:2001–2004.

    PubMed  CAS  Google Scholar 

  2. Hasenberg T, Langle F, Reibenwein B, Schindler K, Post S, Spies C, Schwenk W, Shang E: Current perioperative practice in rectal surgery in Austria and Germany. Int J Colorectal Dis 2010; 5(7):855–863

    Article  Google Scholar 

  3. Counihan TC, Favuzza J: Fast track colorectal surgery. Clin Colon Rectal Surg 2009;22:60–72.

    Article  PubMed  Google Scholar 

  4. Wang D, Kong Y, Zhong B, Zhou X, Zhou Y: Fast-track surgery improves postoperative recovery in patients with gastric cancer: A randomized comparison with conventional postoperative care. J Gastrointest Surg 2010;14:620–627.

    Article  PubMed  Google Scholar 

  5. Koea JB, Young Y, Gunn K: Fast track liver resection: The effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia. HPB Surg 2009;2009:271986.

    Article  PubMed  Google Scholar 

  6. Ionescu D, Iancu C, Ion D, Al-Hajjar N, Margarit S, Mocan L, Mocan T, Deac D, Bodea R, Vasian H: Implementing fast-track protocol for colorectal surgery: A prospective randomized clinical trial. World J Surg 2009;33:2433–2438.

    Article  PubMed  Google Scholar 

  7. Holm B, Kristensen MT, Myhrmann L, Husted H, Andersen LO, Kristensen B, Kehlet H: The role of pain for early rehabilitation in fast track total knee arthroplasty. Disabil Rehabil 2010;32:300–306.

    Article  PubMed  Google Scholar 

  8. Andersen LO, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H: Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 2009;64:508–513.

    Article  PubMed  CAS  Google Scholar 

  9. Pruthi RS, Nielsen M, Smith A, Nix J, Schultz H, Wallen EM: Fast track program in patients undergoing radical cystectomy: Results in 362 consecutive patients. J Am Coll Surg 2010;210:93–99.

    Article  PubMed  Google Scholar 

  10. Chughtai B, Abraham C, Finn D, Rosenberg S, Yarlagadda B, Perrotti M: Fast track open partial nephrectomy: Reduced postoperative length of stay with a goal-directed pathway does not compromise outcome. Adv Urol 2008; doi:10.1155/2008/507543, 507543

  11. Kroon UB, Radstrom M, Hjelthe C, Dahlin C, Kroon L: Fast-track hysterectomy: A randomised, controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151(2):203–207

    Article  PubMed  Google Scholar 

  12. Lohr G, Keller H, Kutscher J, Huber R: [fast-track rehabilitation after open aorto-iliac vascular procedures]. Zentralbl Chir 2008;133:344–348.

    Article  PubMed  CAS  Google Scholar 

  13. Barletta JF, Miedema SL, Wiseman D, Heiser JC, McAllen KJ: Impact of dexmedetomidine on analgesic requirements in patients after cardiac surgery in a fast-track recovery room setting. Pharmacotherapy 2009;29:1427–1432.

    Article  PubMed  CAS  Google Scholar 

  14. Struber M, Winterhalter M: [fast track in cardiac surgery]. Chirurg 2009;80:724–729.

    Article  PubMed  CAS  Google Scholar 

  15. French JJ, Mansfield SD, Jaques K, Jaques BC, Manas DM, Charnley RM: Fast-track management of patients undergoing proximal pancreatic resection. Ann R Coll Surg Engl 2009;91:201–204.

    Article  PubMed  CAS  Google Scholar 

  16. Muhling B, Orend KH, Sunder-Plassmann L: [fast track in thoracic surgery]. Chirurg 2009;80:706–710.

    Article  PubMed  CAS  Google Scholar 

  17. Das-Neves-Pereira JC, Bagan P, Coimbra-Israel AP, Grimaillof-Junior A, Cesar-Lopez G, Milanez-de-Campos JR, Riquet M, Biscegli-Jatene F: Fast-track rehabilitation for lung cancer lobectomy: A five-year experience. Eur J Cardiothorac Surg 2009;36:383–391; discussion 391–382.

    Article  PubMed  Google Scholar 

  18. Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND: Stress response to laparoscopic surgery: A review. Surg Endosc 2004;18:1022–1028.

    Article  PubMed  CAS  Google Scholar 

  19. Yu G, Tang B, Yu PW, Peng ZH, Qian F, Sun G: Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc 2010;24:2860–2870.

    Article  PubMed  Google Scholar 

  20. Kawamura H, Yokota R, Homma S, Kondo Y: Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy. Surg Endosc 2010; 24(11):2739–2742

    Article  PubMed  Google Scholar 

  21. Wind J, Hofland J, Preckel B, Hollmann MW, Bossuyt PM, Gouma DJ, van Berge Henegouwen MI, Fuhring JW, Dejong CH, van Dam RM, Cuesta MA, Noordhuis A, de Jong D, van Zalingen E, Engel AF, Goei TH, de Stoppelaar IE, van Tets WF, van Wagensveld BA, Swart A, van den Elsen MJ, Gerhards MF, de Wit LT, Siepel MA, van Geloven AA, Juttmann JW, Clevers W, Bemelman WA: Perioperative strategy in colonic surgery; laparoscopy and/or fast track multimodal management versus standard care (lafa trial). BMC Surg 2006;6:16.

    Article  PubMed  Google Scholar 

  22. Weimann G, Lev E: Mass-mediated medicine. Isr Med Assoc J 2006;8:757–762.

    PubMed  Google Scholar 

  23. Aikou T, Hokita S, Natsugoe S: [japanese classification of gastric carcinoma (the 13th edition, June 1999): Points to be revised]. Nippon Rinsho 2001;59 Suppl 4:159–165.

    PubMed  Google Scholar 

  24. Dindo D, Demartines N, Clavien PA: Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.

    Article  PubMed  Google Scholar 

  25. Lee JH, Park DJ, Kim HH, Lee HJ, Yang HK: Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien–Dindo classification. Surg Endosc 2011; 26(5):1287–1295. doi:10.1007/s00464-011-2027-0

    Article  PubMed  Google Scholar 

  26. Wilmore DW, Kehlet H: Management of patients in fast track surgery. BMJ 2001;322:473–476.

    Article  PubMed  CAS  Google Scholar 

  27. Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630–641.

    Article  PubMed  Google Scholar 

  28. 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.

    PubMed  Google Scholar 

  29. Nishiguchi K, Okuda J, Toyoda M, Tanaka K, Tanigawa N: Comparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma. Dis Colon Rectum 2001;44:223–230.

    Article  PubMed  CAS  Google Scholar 

  30. Yu G, Tang B, Yu PW, Peng ZH, Qian F, Sun G: Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc 2010

  31. Lee JH, Yom CK, Han HS: Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 2009;23:1759–1763.

    Article  PubMed  Google Scholar 

  32. Etoh T, Shiraishi N, Kitano S: Laparoscopic gastrectomy for cancer. Dig Dis 2005;23:113–118.

    Article  PubMed  Google Scholar 

  33. Grantcharov TP, Kehlet H: Laparoscopic gastric surgery in an enhanced recovery programme. Br J Surg 2010;97:1547–1551.

    Article  PubMed  CAS  Google Scholar 

  34. Lee JH, Han HS: A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: Early results. Surg Endosc 2005;19:168–173.

    Article  PubMed  Google Scholar 

  35. Henriksen MG, Jensen MB, Hansen HV, Jespersen TW, Hessov I: Enforced mobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery. Nutrition 2002;18:147–152.

    Article  PubMed  CAS  Google Scholar 

  36. Fukuzawa J, Terashima H, Ohkohchi N: Early postoperative oral feeding accelerates upper gastrointestinal anastomotic healing in the rat model. World J Surg 2007;31:1234–1239.

    Article  PubMed  Google Scholar 

  37. Hou H, Ping X, Zhu Y, Zhao Z, Li Y, Li J: Dietary fiber alleviates intestinal barrier dysfunction in post-trauma rats. Clin Invest Med 2010;33:E117.

    PubMed  CAS  Google Scholar 

  38. Sagar PM, Holdsworth PJ, Godwin PG, Quirke P, Smith AN, Johnston D (1992) Comparison of triplicated (s) and quadruplicated (w) pelvic ileal reservoirs. Studies on manovolumetry, fecal bacteriology, fecal volatile fatty acids, mucosal morphology, and functional results. Gastroenterology 102:520–528.

    PubMed  CAS  Google Scholar 

  39. Nelson R, Tse B, Edwards S: Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005;92:673–680.

    Article  PubMed  CAS  Google Scholar 

  40. Livingston EH, Passaro EP, Jr.: Postoperative ileus. Dig Dis Sci 1990;35:121–132.

    Article  PubMed  CAS  Google Scholar 

  41. Lewis SJ, Andersen HK, Thomas S: Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: A systematic review and meta-analysis. J Gastrointest Surg 2009;13:569–575.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Dr. Xue-Jun Gao for helpful advice, and Lei Chen for experimental and technical assistance.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, No. 20 Yuhuangding East Road, Yantai, Shandong, 264000, China

    Jin chen Hu, Li xin Jiang, Hai tao Zheng, Hong bing Chen, Guo chang Wu, Yi fei Zhang & Zhong chuan Lv

  2. Department of Pathology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, No. 20 Yuhuangding East Road, Yantai, Shandong, 264000, China

    Li Cai

  3. Department of General Surgery, Qilu Hospital, Shandong University, No.107 Wenhua West Road, Jinan, Shandong, 250012, China

    San yuan Hu

Authors
  1. Jin chen Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li xin Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hai tao Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. San yuan Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hong bing Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guo chang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yi fei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhong chuan Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li xin Jiang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

chen Hu, J., xin Jiang, L., Cai, L. et al. Preliminary Experience of Fast-Track Surgery Combined with Laparoscopy-Assisted Radical Distal Gastrectomy for Gastric Cancer. J Gastrointest Surg 16, 1830–1839 (2012). https://doi.org/10.1007/s11605-012-1969-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-1969-4

Keywords

Search

Navigation