Clinical efficacy of enhanced recovery after surgery in the radical gastrectomy for gastric cancer: a prospective study

Abstract

Objective To investigate the clinical efficacy of enhanced recovery after surgery (ERAS) in the radical gastrectomy for gastric cancer. Methods The clinical data of 140 patients undergoing radical gastrectomy for gastric cancer at the Affiliated Hospital of Qingdao University from April 2011 to June 2013 were prospectively analyzed. A double-blind, randomized, controlled study was performed in the 140 patients, and all of them were divided into the ERAS group (patients undergoing perioperative management according to enhanced recovery rehabilitation program) and the control group (patients undergoing perioperative management) based on a random numble table. The inflammatory markers, nutritional index and postoperative recovery of patients were observed. Patients of the ERAS group were followed up by telephone interview within the first 24 hours after discharge, and by outpatient examination since the second week after discharge. The follow-up was ended at postoperative day 30. Patients of the control group were reexamined at the third week after discharge. The measurement data with normal distribution was presented as ±s.The comparison between groups was evaluated with an independent sample t test. The trend analyses for variables were done using repeated measures ANOVA. The count data were analyzed using the chi-square test or Fisher exact probability. Results Eighty patients were screened for eligibility, and were allocated into the ERAS group (40 patients) and the control group (40 patients). The total protein in serum (TP), albumin (Alb), prealbumin, TNF-α, IL-6, c-reactive protein, resting energy expenditure (REE), glycemic index, insulin index and Insulin resistance index in the 2 groups showed a range of variations at postoperative day 1, 3, and 5, and these were (61±5) g/L, (34±3) g/L, (160±18) g/L, (12.3±2.3) mmol/L, (101±34) ng/L, (43±11) g/L, (1 336±105) kal/d, (7.6±0.8) mmol/L, (16.8±3.5) mU/L and 5.7±1.3 in the ERAS group at postoperative day 1, and (58±4) g/L, (31±4) g/L, (147±18) g/L, (15.3±2.2) mmol/L, (122±37) ng/L, (56±27) g/L, (1 450±164) kal/d, (9.3±1.4) mmol/L, (30.5±6.8) mU/L and 12.5±3.2 in the control group, respectively, showing a significant difference between the 2 groups (F=31. 63, 8. 03, 67. 36, 147. 04, 9. 63, 6. 84, 16. 10, 54. 85, 104. 51, 139. 47, P 0.05). Conclusions ERAS is safe and feasible for the perioperative treatment of patients with gastric cancer, meanwhile it could reduce the surgical stress, shorten the duration of hospital stay and improve QOL and postoperative complications, ERAS might take effects by reducing insulin resistance and decreasing REE. Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTR-TRC-10001611. Key words: Gastric neoplasms; Enhanced recovery after surgery; Inflammatory response; Nutritional status; Insulin resistance; Energy metabolism