Y Zhang1,2, G Ji3, K Tao4, H Liang5, S Lei6, X Zhong7, X Wang8, J Yu9, C Chen10, J Zhao11, Q Zheng12, Q Wang13, Y Luo2,14, Y Li2,14, J Wang2,1,14. 1. Shantou University Medical College, Shantou 515041, China. 2. Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. 3. Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, Air Force Medical University, Xi'an 710032, China. 4. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. 5. Department of Gastrointestinal Surgery, Zhuhai Hospital Affiliated with Jinan University, Zhuhai 519000, China. 6. Department of Gastrointestinal Surgery, Second Xiangya Hospital of Central South University, Changsha 410011, China. 7. Department of Surgical Treatment of Gastrointestinal Hernia And Fistula, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China. 8. Department of General Surgery, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou 515041, China. 9. Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510000, China. 10. Department of Gastrointestinal Surgery, Huizhou Municipal Central Hospital, Huizhou 516001, China. 11. Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat- Sen University, Jiangmen 529070, China. 12. Department of Gastrointestinal Surgery, Guangdong Second Provincial General Hospital, Guangzhou 510317, China. 13. Department of Gastrointestinal Surgery, Guangzhou First People's Hospital, Guangzhou 510180, China. 14. Second School of Clinical Medicine, Southern Medical University, Guangzhou 510260, China.
Abstract
OBJECTIVE: To evaluate the clinical efficacy of laparoscopic and open gastrectomy in enhanced recovery after surgery (ERAS) for gastric cancer. METHODS: We retrospectively collected the clinicopathological data of gastric cancer patients undergoing radical gastrectomy at 12 Chinese medical centers between January, 2015 and December, 2017. We analyzed the clinical outcomes of a total of 1569 patients, including 552 patients undergoing open surgery, 1004 receiving laparoscopic surgery, and 43 experiencing conversion of laparoscopic surgery to open surgery. The operative outcomes and postoperative complications of the patients in laparoscopic group and open surgery group were analyzed. The primary outcome was the short-term postoperative complications. The secondary outcomes included operation time, estimated blood loss, number of lymph node dissection, time to first liquid diet intake, time to first passage of flatus and defecation, time to ambulation, postoperative hospitalization days and occurrence of readmission within 30 days. RESULTS: Of the total of 1569 patients, 1037 (66.1%) were males and 532 (33.9%) were females, with a mean age at diagnosis of 58.4±11.3 years. A total of 105 patients (6.7%) underwent proximal gastrectomy, 877 (55.9%) underwent distal gastrectomy, and 587 (37.4%) underwent total gastrectomy. In the overall patients, the operation time was 274.7±80.7 mins, blood loss was 150 (20-1300) mL, and the number of lymph nodes dissected was 29.9±13.5. The time to first ambulation, flatus, defecation and liquid food intake were 2.3±1.2, 3.4±1.6, 4.8±1.8 and 5.5±3.1 days, respectively. The postoperative hospital stay was 11.4±5.0 days. The incidence of postoperative complications (Clavien-Dindo score ≥Ⅱ) was 6.5%, and the rate of readmission within 30 days after discharge was 1.1%. Subgroup analysis of the patients based on the surgical approach (conversion of laparoscopic surgery to open surgery was considered open surgery) showed no significant differences in the extent of gastrectomy between laparoscopic and open surgery groups (P > 0.05). Compared with those in the open surgery group, the patients having laparoscopic gastrectomy had a greater number of lymph nodes retrieved with earlier ambulation, first flatus, defecation and oral intake and a shorter postoperative hospital stay (P < 0.05). The laparoscopic group had a lower intraoperative blood loss but a longer operation time than the open surgery group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05). CONCLUSION: Compared with open surgery, laparoscopic surgery in ERAS can shorten the time to ambulation, first flatus, defecation, and oral intake and the length of hospital stay. Laparoscopic surgery can achieve the same oncological outcomes as open surgery without increasing postoperative complications.
OBJECTIVE: To evaluate the clinical efficacy of laparoscopic and open gastrectomy in enhanced recovery after surgery (ERAS) for gastric cancer. METHODS: We retrospectively collected the clinicopathological data of gastric cancer patients undergoing radical gastrectomy at 12 Chinese medical centers between January, 2015 and December, 2017. We analyzed the clinical outcomes of a total of 1569 patients, including 552 patients undergoing open surgery, 1004 receiving laparoscopic surgery, and 43 experiencing conversion of laparoscopic surgery to open surgery. The operative outcomes and postoperative complications of the patients in laparoscopic group and open surgery group were analyzed. The primary outcome was the short-term postoperative complications. The secondary outcomes included operation time, estimated blood loss, number of lymph node dissection, time to first liquid diet intake, time to first passage of flatus and defecation, time to ambulation, postoperative hospitalization days and occurrence of readmission within 30 days. RESULTS: Of the total of 1569 patients, 1037 (66.1%) were males and 532 (33.9%) were females, with a mean age at diagnosis of 58.4±11.3 years. A total of 105 patients (6.7%) underwent proximal gastrectomy, 877 (55.9%) underwent distal gastrectomy, and 587 (37.4%) underwent total gastrectomy. In the overall patients, the operation time was 274.7±80.7 mins, blood loss was 150 (20-1300) mL, and the number of lymph nodes dissected was 29.9±13.5. The time to first ambulation, flatus, defecation and liquid food intake were 2.3±1.2, 3.4±1.6, 4.8±1.8 and 5.5±3.1 days, respectively. The postoperative hospital stay was 11.4±5.0 days. The incidence of postoperative complications (Clavien-Dindo score ≥Ⅱ) was 6.5%, and the rate of readmission within 30 days after discharge was 1.1%. Subgroup analysis of the patients based on the surgical approach (conversion of laparoscopic surgery to open surgery was considered open surgery) showed no significant differences in the extent of gastrectomy between laparoscopic and open surgery groups (P > 0.05). Compared with those in the open surgery group, the patients having laparoscopic gastrectomy had a greater number of lymph nodes retrieved with earlier ambulation, first flatus, defecation and oral intake and a shorter postoperative hospital stay (P < 0.05). The laparoscopic group had a lower intraoperative blood loss but a longer operation time than the open surgery group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05). CONCLUSION: Compared with open surgery, laparoscopic surgery in ERAS can shorten the time to ambulation, first flatus, defecation, and oral intake and the length of hospital stay. Laparoscopic surgery can achieve the same oncological outcomes as open surgery without increasing postoperative complications.
Entities:
Keywords:
complications; enhanced recovery after surgery; gastric cancer; laparoscopy
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