Wang Bin, Yao Yizhou, Wang Xuchao, Li Hao, Qian Huan, Jiang Linhua, Zhu Xinguo
Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Medicine (Baltimore). 2020 May 22;99(21):e20325. doi: 10.1097/MD.0000000000020325.
Gastric cancer (GC) continues to be 1 of the malignant tumors with high morbidity and mortality worldwide. Although the improvements in targeted inhibitor therapy have promoted survival, the first choice for GC patients is still surgery. However, prolonged surgery may tire surgeons and affect surgical outcomes.To detect whether different time-of-day radical gastrectomy influenced short-term and long-term surgical outcomes.This study included 117 patients between 2008 and 2012 who underwent a radical gastrectomy. These patients were grouped into the morning (before 13:00) and afternoon (after 13:00) groups or divided into 2 groups according to the median operation start time (before or after 11:23). Then, the relevant influence of the surgical start time was analyzed.The morning group (before 13:00) and the front median group (before 11:23) showed longer operative time (P = .008 and P = .016, respectively), lower estimated blood loss (P < .001 and P = .158, respectively), and longer time before resuming oral intake (P < .001 and P < .173, respectively) than the afternoon group (after 13:00) or latter median group (after 11:23). Starting the operation in the morning had no effect on the rate of postoperative complications. The operation start time had no significant influence on the overall survival of patients who underwent a radical gastrectomy. However, in subgroup analysis, patients who underwent a distal gastrectomy faced poor prognosis when their surgery started after 13:00 (P = .030).The results suggest that the operation start time might be an indicator of total operative time, estimated blood loss, and the time to resuming oral intake. The operation start time may also influence the prognosis of radical gastrectomy in patients with GC.
胃癌（GC）仍然是全球发病率和死亡率较高的恶性肿瘤之一。尽管靶向抑制剂治疗的进展提高了生存率，但胃癌患者的首选治疗方法仍是手术。然而，长时间的手术可能会使外科医生疲劳并影响手术效果。为了检测不同手术时间进行的根治性胃切除术是否会影响短期和长期手术效果。本研究纳入了2008年至2012年间接受根治性胃切除术的117例患者。这些患者被分为上午组（13:00之前）和下午组（13:00之后），或者根据手术开始时间的中位数（11:23之前或之后）分为两组。然后，分析手术开始时间的相关影响。上午组（13:00之前）和前中位数组（11:23之前）的手术时间比下午组（13:00之后）或后中位数组（11:23之后）更长（分别为P = 0.008和P = 0.016），估计失血量更低（分别为P < 0.001和P = 0.158），恢复经口进食的时间更长（分别为P < 0.001和P < 0.173）。上午开始手术对术后并发症发生率没有影响。手术开始时间对接受根治性胃切除术患者的总生存率没有显著影响。然而，在亚组分析中，接受远端胃切除术的患者在13:00之后开始手术时预后较差（P = 0.030）。结果表明，手术开始时间可能是总手术时间、估计失血量和恢复经口进食时间的一个指标。手术开始时间也可能影响胃癌患者根治性胃切除术的预后。
