Abstract
This study discusses the effect and clinical significance of fast-track surgery (FTS) combined with laparoscopic radical surgery on the plasma level of vascular endothelial growth factor (VEGF) in locally advanced gastric antrum cancer. Plasma VEGF levels were detected in 63 cases of locally advanced gastric antrum cancer by using double-antibody sandwich Avidinbiotincomplex-ELISA before and after operation. The pure laparoscopic surgery group (group A) comprised 30 cases, and the combined FTS group (group B) consisted of 33 cases. Results of the two groups were obtained at similar time points and then compared. The VEGF levels were not significantly different between the two groups on the first day before the operation and on the first day, third day, and sixth month after the operation (P > 0.05). However, the differences were significant on the seventh day and first month after the operation (P < 0.05). The postoperative eating time, anal exhaust time, and hospital stay of the patients were statistically significantly different between the two groups (P < 0.05). Nevertheless, no significant differences were detected in terms of wound healing time and complications (P > 0.05). The 3-year survival rate significantly differed between the two groups (P < 0.05). FTS combined with laparoscopic surgery can decrease the postoperative VEGF level compared with pure laparoscopic surgery. The combined approach improved postoperative recovery without prolonging the wound healing time or increasing the incidence of postoperative complications. The 3-year survival rate also increased. Thus, FTS combined with laparoscopic surgery can improve the prognosis in gastric antrum cancer.
Highlights
Gastric cancer is a prevalent malignant cancer worldwide and ranks second among all cancers in terms of mortality (Parkin et al 2005)
The postoperative hospital stay was shortened in the combined fast-track surgery (FTS) group compared with that in the pure laparoscopic group (18.5 ± 5.5 vs. 11.0 ± 2.0); the first anal exhaust time (4.0 ± 1.0 vs. 2.5 ± 0.5) and the postoperative eating time were statistically significantly earlier than those in the pure laparoscopic group (P < 0.05)
The following additional measures were performed in the combined FTS group: preoperative education and nutrition support therapy were enhanced; the postoperative fasting time was shortened; the nutrition canal was indwelled by 20–30 cm from the distal end of the anastomotic stoma; insulation was conducted, and 5-hydroxytryptamine receptor antagonist was given to relieve nausea and vomiting; the patients started eating and moving around at an earlier time; and sufficient analgesic measures were administered
Summary
Gastric cancer is a prevalent malignant cancer worldwide and ranks second among all cancers in terms of mortality (Parkin et al 2005). Surgery is the commonly used and the most effective approach for treatment of gastric cancer. Laparoscopic surgery has provided a new solution to gastric cancer treatment. (2001) first reported treatment of advanced gastric cancer by using laparoscopic D2 radical gastrectomy in 1997. The safety and feasibility of this approach have been recognized by many scholars. Postoperative recovery involves the synergism of various factors. Wilmore et al (Wilmore and Kehlet 2001; Kehlet and Wilmore 2002) proposed the concept of fast-track surgery (FTS) in 2001; FTS aims to adopt optimized measures for perioperative treatment by resorting to evidence-based medicine. FTS can facilitate postoperative recovery by reducing postoperative physical and psychological stresses. During recovery and repair of cells and tissues, vascular
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