Pędziwiatr M, Matłok M, Kisialeuski M, Migaczewski M, Major P, Winiarski M, Budzyński P, Zub-Pokrowiecka A, Budzyński A
2nd Department of General Surgery, Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
Eur Surg. 2014;46(3):128-132. doi: 10.1007/s10353-014-0264-x. Epub 2014 Jun 7.
Recently, first reports on benefits from Enhanced Recovery After Surgery (ERAS) pathway in patients undergoing gastric surgery have appeared. It seems that maximal reduction of unfavorable surgery-induced trauma in patients with gastric malignancy via ERAS protocol combined with minimally invasive techniques can improve outcomes.
The aim of this study was to determine the influence of laparoscopic surgery and ERAS protocol in oncological gastric surgery on early outcomes.
Prospective analysis involved 28 patients (18 female and 10 male) with gastric malignancy who underwent laparoscopic gastric resection between 2009 and 2013. Gastric tumors (gastrointestinal stromal tumors or adenocarcinoma) were the indication for the surgery. A total of 17 patients underwent laparoscopic local excision, and 11 patients with adenocarcinoma or multiple neuroendocrine tumors underwent laparoscopic D2 total gastrectomy. Perioperative care was based on ERAS principles. Length of hospital stay, postoperative course, perioperative complications, and readmission rates were analyzed.
There was one conversion in the gastrectomy group. All patients were mobilized on the day of surgery. Oral fluids were introduced on day 0 and were well tolerated. Full hospital diet was started on day 2 in all patients, but was well tolerated in only 18 of them. One postoperative complication requiring reoperation was noted. The length of stay after gastrectomy and gastric wedge resection was 4.6 (2-6) and 3.3 (2-6) days, respectively. No readmissions were noted in the entire group.
The implementation of ERAS protocol to clinical practice in combination with laparoscopy in patients with gastric tumors can result in improved postoperative care quality, shortening of hospital stay, and quicker return to normal activity.
最近，有关胃癌手术患者采用加速康复外科（ERAS）路径的益处的首批报告已出现。似乎通过ERAS方案结合微创技术，最大程度减少胃癌患者手术引起的不良创伤可改善预后。
本研究旨在确定腹腔镜手术和ERAS方案在胃癌肿瘤手术中对早期预后的影响。
前瞻性分析纳入了2009年至2013年间接受腹腔镜胃切除术的28例胃癌患者（18例女性和10例男性）。胃肿瘤（胃肠道间质瘤或腺癌）是手术指征。共有17例患者接受了腹腔镜局部切除术，11例腺癌或多发神经内分泌肿瘤患者接受了腹腔镜D2全胃切除术。围手术期护理基于ERAS原则。分析住院时间、术后病程、围手术期并发症和再入院率。
胃切除组有1例中转开腹。所有患者均在手术当天即可活动。术后第0天开始口服液体，耐受性良好。所有患者均于术后第2天开始进全量医院饮食，但只有18例耐受性良好。记录到1例需要再次手术的术后并发症。胃切除术后和胃楔形切除术后的住院时间分别为4.6（2 - 6）天和3.3（2 - 6）天。全组无再入院情况。
将ERAS方案与腹腔镜技术相结合应用于胃癌患者的临床实践中，可提高术后护理质量，缩短住院时间，并更快恢复正常活动。
