Fast Track Surgery Group Research Articles

Fast-track surgery with three-port versus conventional perioperative management of bladder cancer associated laparoscopic radical cystectomy and Ileal conduit diversion: Chinese experience

ObjectiveThis study seeks to explore the impact of fast track surgery (FTS) with three-port in patients treated with laparoscopic radical cystectomy and ileal conduit on postoperative recovery, hospital stay and the complications.MethodsThis retrospective study analyzed 230 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy at the Second Hospital of Anhui Medical University between December 2011 to January 2023. 50 patients received conventional surgery (CS) and 180 patients received FTS with three-port. Patients were assessed for time to normal diet consumption, time to passing first flatus, number of postoperative recovery days and complications. Trends of serum C-reactive protein levels were monitored preoperatively and on postoperative days 1, 3 and 7.ResultsPatients who underwent FTS with three-port had a shorter duration to first flatus (P < 0.05). And number of postoperative hospital days and the length of hospital stay were notably shorter in contrast to the CS group (P < 0.05). Serum CRP levels on postoperative day 7 were markedly reduced in those of the FTS group compared to the CS group (P < 0.05). Those of the CS group experienced more frequent rates of complications compared to those of the FTS with three-port group (P < 0.05).ConclusionOur findings demonstrate that the FTS with three-port program hastens postoperative recovery and reduces duration of hospital stay. It is safer and more effective than the CS program in the Chinese population undergoing laparoscopic radical cystectomy.

Fast-Track surgery protocol in perioperative care for gynecological laparoscopy.

This study aimed to compare fast-track surgery (FTS) and traditional perioperative care protocols in laparoscopic gynecological surgeries, assessing their impact on length of stay (LOS), recovery time, and postoperative complications. A case-control retrospective study was conducted at Suzhou Hospital of Integrated Chinese and Western Medicine, involving 167 patients undergoing laparoscopic gynecological surgery from June 2021 to June 2023. Of them, 81 patients underwent surgery based on the FTS protocol (FTS group) and 86 patients received a traditional perioperative management (control group). Patients in both groups underwent gynecologic laparoscopic procedures, including uterine, ovarian and tubal surgeries. Data were collected on general patients' characteristics, including age, BMI, surgery type and time, intestinal recovery and out-of-bed activity time, LOS, pain levels, and postoperative complications. Wilcoxon rank sum test with continuity correction was used to assess the difference in operative characteristics and postoperative pain levels. Fisher's exact test was used to assess the difference in overall frequency of postoperative complications between groups. Patients in the FTS group exhibited faster intestinal recovery, shorter mobilization time, and reduced LOS compared to the control group. Pain levels were significantly lower at one, six and twelve hours post-surgery in the FTS group. Overall, the proportion of postoperative complications was significantly lower in the FTS group than in the control group. Implementing the FTS protocol in laparoscopic gynecological surgeries for benign conditions can reduce LOS, accelerate recovery, and minimize pain without increasing postoperative complications. Further research with more diverse patient populations is warranted to validate these findings.

Nursing measures in the fast-track surgery on negative emotions in breast cancer patients: A meta-analysis.

To critically evaluate the effects of different nursing measures based on the concept of fast-track surgery (FTS) on the negative emotions of patients with breast cancer. A systematic search of 8 databases, namely PubMed, Cochrane Library, Embase, Psycho info, China national knowledge infrastructure, Wanfang, China science and technology journal database, and China biomedical literature database, was performed to find randomized controlled trials from inception to April 2023. Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. Ten studies were included in the systematic review, with a total of 830 patients (FTS group: 415; control group: 415). The results showed that different nursing measures based on the concept of FTS could significantly reduce anxiety (MD = -1.74, 95% confidence intervals [-2.41, -1.08], P < .00001) and depression (MD = -1.98, 95% confidence intervals [-2.44, -1.51], P < .00001) in patients after modified breast cancer surgery compared with the control group. Based on the concept of FTS, the nursing measures such as reducing preoperative fasting time, posture management, preventive analgesia, and early functional exercise can effectively reduce the anxiety and depression of patients during the perioperative period.

Effect of Fast-Track Surgery under ERAS protocol in Laparoscopic Hysterectomy: A Randomized Controlled Trial

Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy.Materials & Methods: 260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery.Results: A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups.Conclusion: Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.

Fast-track versus conventional surgery in relation to time of hospital discharge following total hip arthroplasty: a single-center prospective study

BackgroundTotal hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is a surgical procedure associated with prolonged hospital length of stay (LOS). The aim of this study was to analyze whether a protocol developed for fast-track THA could decrease the time taken to reach functional recovery after surgery and the hospital LOS. Blood transfusion and critical care requirements and the complication rate were evaluated as secondary endpoints.MethodsNinety-eight patients underwent THA at the University Hospital of the Federal University of Maranhão (São Luís, Brazil). The control group included 51 patients who underwent THA through the conventional method. The fast-track surgery (FTS) group included 47 patients who underwent THA through the FTS approach. The inclusion criteria were that the subjects needed to present hip osteoarthritis and at least one clinical indication for THA, and that their risk classification was in ASA category I or II. The following factors were evaluated: age, sex, diagnosis, laterality, type of arthroplasty, blood transfusion, critical care requirement, complications, LOS, and need for re-hospitalization for any reason. For spinal anesthesia, an opioid-free protocol was used. Comparison of categorical variables between the groups was performed using the chi-square test, Shapiro-Wilk test, Student t test, and Poisson regression approach.ResultsThe FTS and control groups were similar in age and sex distribution (p > 0.05). The majority of the patients in the control group required both blood transfusion and use of the critical care unit, thus differing from the patients who underwent FTS (p < 0.001). The mean hospital LOS in the FTS group was 2.3 ± 0.8 days, compared with 6.4 ± 1.5 days in the control group (p < 0.001).ConclusionUse of FTS was associated with decreased LOS, compared with conventional THA.Trial registrationhttps://www.researchsquare.com/article/rs-369025/v1.

Effect of fast-track surgery in gynecological laparoscopy: a randomized controlled trial†

Abstract Objective To evaluate the value of fast-track surgery (FTS) in gynecological laparoscopy during the perioperative period. Methods The clinical data of 234 patients who underwent gynecological laparoscopy from January to December in 2018 were collected. Of note, 117 patients received a routine nursing method (control group), and 117 patients received the FTS nursing method (observation group). Results Compared with the control group, FTS group had a quicker postoperative bowel function recovery, earlier to get out of bed, and a lower anxiety level (P &lt; 0.05); The incidence of postoperative nausea and vomiting of two groups had no statistical difference. Conclusions The application of FTS in gynecological laparoscopy is safe, effective, and worth promoting.

Effects of a fast track surgery nursing program in perioperative care of older patients with a hip fracture.

The nursing concept has changed from being "disease centered" to "patient centered". The aim of this study was to explore the clinical effects of a fast track surgery nursing program in the perioperative care of older patients with a hip fracture. Total of 84 patients with hip fracture who were hospitalized in our department were randomly divided into the conventional group (42 cases) and fast track surgery group (42 cases) to compare the psychological state, pain degree, serum inflammatory factors, coagulation, hip function, and incidence of deep venous thrombosis of lower extremities between the groups before and after the nursing program. There were no significant differences between groups as measured by a self-rating anxiety scale, self-rating depression scale, visual analogue score, IL-6, IL-10, TNF-α, coagulation factor level, or Harris score between groups before nursing (P > 0.05). The self-rating anxiety scale, self-rating depression scale, visual analogue score, IL-6, IL-10, TNF-a, coagulation factor level, and deep venous thrombosis in fast track surgery group after nursing were significantly lower than in the conventional group, and the Harris score was significantly higher (P < 0.05). The fast track surgery nursing program can effectively alleviate adverse emotions and pain of patients with a hip fracture, reduce inflammation, improve coagulation and hip function after operation, and reduce the incidence of deep venous thrombosis after operation.

Effect of low-frequency electrical acupoint stimulation on gastrointestinal motility function following radical gastrectomy in patients with gastric cancer

To observe the effect of low-frequency electrical acupoint stimulation on gastrointestinal motility in patients undergoing radical gastrectomy, and its impact on regulation of inflammatory response, so as to evaluate its clinical value. A total of 177 patients undergoing radical gastrectomy were randomly divided into conventional group (n＝43), low-frequency electrical acupoint stimulation (LEAS) group (n＝45), fast track surgery (FTS) group (n＝46) and FTS＋LEAS group (n＝43). Patients of the conventional group received conventional treatment (pre-surgical mechanical bowel preparation, post-surgical fasting, and indwelling abdominal drainage tube, etc.). Patients in the LEAS group were treated by low-frequency electrical stimulation at bilateral Zusanli (ST36), Shangjuxu(ST37), Xiajuxu(ST39) and Sanyinjiao(SP6) for 30 min, once daily from 1 day after the operation to first postoperative flatus. FTS group was given fast track surgery treatment, such as preoperative education, preoperative nutritional support, early oral feeding, early removal of abdominal drainage tube, etc. The FTS＋LEAS group was given low-frequency electrical acupoint stimulation on the basis of the FTS treatment. Levels of white blood cells (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at 1, 3, and 6 d after the operation in the 4 groups were assayed. The first postoperative flatus and defecation time were recorded. After the treatment, the first postoperative flatus and defecation time in the LEAS, FTS and FTS＋LEAS groups were significantly shorter than those of the conventional group (P<0.05), and the first flatus time of the FTS＋LEAS group was even earlier than that of the FTS group (P<0.05). No significant differences were found among the 3 groups in the postoperative defecation time (P>0.05). The CRP levels in the 4 groups on 3 and 6 d after operation were higher than those on the 1st postoperative day, and the highest level was on 3 d after the operation. Compared with the conventional group, CRP level on 3 d and CRP and IL-6 levels on 3 and 6 d in the LEAS and FTS＋LEAS groups were significantly lower (P<0.05). Compared with the LEAS group, the levels of N, CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS group were significantly increased (P<0.05). Compared with the FTS group, the level of CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS＋LEAS group were significantly decreased (P<0.05). FTS combined with LEAS is superior to simple FTS or LEAS treatment in shortening the first flatus and defecation time and promoting the recovery of gastrointestinal motility function in patients undergoing radical gastrectomy, which may be associated with its effect in alleviating postoperative inflammatory responses.

Effect of fast-track surgery on inflammatory response and immune function in patients with laparoscopic distal gastrectomy

Enhanced recovery after surgery can reduce immunosuppression and inflammation in patients with laparoscopic distal gastrectomy The aim of this study was to investigate the effect of fast-track surgery on inflammatory response and immune function in patients with laparoscopic radical gastrectomy. A total of 244 patients undergoing laparoscopic radical gastrectomy for gastric cancer from January 2014 to December 2017 were collected. The patients were divided into fast-track surgery (FTS) and traditional groups. The inflammatory index, immune index, and postoperative complications were measured before and after the operation. There was no significant difference in immune index between the two groups on the day before operation and one day after operation, all P > 0.05. On POD3 and POD6, the expression of CD3+, CD4+, CD4+/CD8+, IgG, IgM, and IgA in the FTS group was higher than that in the traditional group and the difference was statistically significant (P < 0.05).There was no significant difference in inflammation index between the two groups on the day before operation; on POD1, POD3, and POD6, the expression of IL-6, TNF-α, and CRP in the FTS group was lower than in the traditional group and the difference was statistically significant (P < 0.05). The total postoperative complications in the FTS group were significantly lower than those in the traditional group and the difference was statistically significant (P < 0.05). Fast-track surgery can effectively reduce the degree of postoperative inflammatory reaction and the incidence of postoperative complications compared with the traditional group and has a smaller impact on the body’s immune function, which is worthy of promotion in clinical practice.

Fast-Track Approach for Breast Reconstructive Surgery in Patients With Breast Cancer.

Aim:The aim of this study was to develop and implement the concept of fast-track surgery (FTS) for reconstructive breast surgery in patients with breast cancer (BC) to improve early and long-term results of treatment.Materials and methods:The study includes 749 patients with stage 1 to 3 BC. A total of 253 patients with BC got treatment according to FTS program and were included to the core group. Other 496 patients with BC (control group) were not included to the FTS program. Patients were treated from December 2010 to December 2014. All age groups were covered (18-70 years old).Results:There was a significant difference in the average length of hospital stay (LOS) which was 14.27 ± 7.00 days in the core group and 20.11 ± 7.70 days in the control group (P < .001). In advanced BC cases in the core group, LOS was >8 days lower comparing with the control group on average. The LOS in patients who underwent adjuvant chemotherapy was 2.7 times lower in the FTS group comparing with the control group.Conclusions:The study results allow us to recommend the concept of FTS for implementation in broad medical practice for breast reconstructive surgery in patients with BC. The FTS program was shown to be effective in all types of breast surgery, including immediate oncoplastic and reconstructive surgeries. The gradual reduction of LOS increased the number of surgeries in our department by 75% from 2008 till 2018.

Application of fast track surgery in surgical treatment of distal radius fractures in the elderly

Objective To investigate the clinical efficacy of fast track surgery in surgical treatment of internal fixation for the elderly patients with distal radius fractures. Methods From January 2014 to December 2015, 121 elderly patients (age≥65 years) with distal radius fractures who treated with internal fixation by anatomic locking plate through volar approach were retrospectively analyzed. 64 cases were treated by fast track surgery (group A) and 57 cases received routine treatment during perioperative period (group B). The perioperative complications, hospitalization time and wrist function of the two groups were compared, and the short-term clinical effects of the two groups were observed. Results In group A, the incidence of central nervous system disease, the incidence of nausea and vomiting, VAS score at 48 hours after the operation and the time of postoperative hospitalization were lower than those in group B (P=0.006,P=0.014,P=0.000,P=0.000). At 12 weeks postoperatively, wrist Gartland-Werley score in group A was significantly better than that in group B. Conclusion The application of fast track surgery in the elderly with distal radius fractures can promote early rehabilitation, shorten hospitalization time and reduce related complications. Key words: Radius fractures; Treatment outcome; Fast track surgery; Elderly; Perioperative period

Comparison of Fast-Track Versus Conventional Surgery Protocol for Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Chinese Experience

Fast-track surgery (FTS), which includes a series of evidence-based adjustments, is expected to reduce complications, relieve surgical stress reaction, accelerate recovery, and shorten hospitalization, as well as improve safety. The aim of this study was to critically evaluate the safety and effectiveness of FTS in Chinese prostate cancer (Pca) patients who underwent robot-assisted laparoscopic prostatectomy (RALP). A retrospective analysis was performed on 73 consecutive Chinese Pca patients who underwent RALP and who were divided into two groups: conventional surgery (CS) and FTS. Preoperative clinical data, intraoperative characteristics, postoperative outcomes and incidence of complications were compared between the two groups. No significant differences in preoperative parameters were observed between the two groups. Compared with the CS group, the FTS group showed a significantly shorter time to first flatus, time to regular diet, postoperative hospitalization time, lower incidence of complications, and lower reactions of postoperative stress and pain. Our study demonstrates that FTS is feasible and safe for Chinese Pca patients undergoing RALP and that it accelerates recovery, attenuates surgical stress response, and reduces morbidity compared to CS.

Application of fast track surgery in routine nursing for patient with colorectal cancer.

Objective: To investigate the clinical effect of fast track surgery (FTS) in perioperative nursing of colorectal cancer surgery. Background: In recent years, many complicated surgery began to develop in the direction of low invasion and short hospital time, which provides an unprecedented opportunity for the development of fast track surgery (FTS). Methods: According to different nursing measures, 156 cases of colorectal cancer patients treated in our hospital were divided into FTS nursing group (86 cases) and traditional nursing group (70 cases). FTS nursing care and traditional nursing care were respectively employed to analyze and compare postoperative recovery and complications of the two groups. Results: FTS nursing group was significantly shorter than the traditional care group in terms of the first postoperative exhaust time, the first defecation time, the first eating time, ambulation time and postoperative hospital time, with statistical significance (P < .05); compared with the conventional nursing group, FTS group significantly had lower incidence of postoperative intestinal obstruction, lower limb vein thrombus formation and gastrointestinal discomfort, with statistical significance (P < .05); FTS group has less situations of nausea and vomiting, incision infection, pulmonary infection, urinary tract infection and anastomotic leakage compared to the conventional nursing group. Conclusion: FTS nursing can effectively promote the postoperative recovery of intestinal function for patients with colorectal cancer and reduce the occurrence of postoperative complications, which will relieve postoperative pain and shorten the length of stay, giving patients increased rehabilitation quality.

Meta-analysis of clinical application of rapid rehabilitation surgery in caesarean section

Objective To systematically assess the safety and efficacy of using fast track surgery (FTS) technique in the setting of caesarean section. Methods The following electronic databases as PubMed, EMBASE, the Cochrane Library, CBM and CNKI were retrieved on computer from their establishment to April 2016 to search for randomized controlled trials (RCT) about FTS in the setting of caesarean section, and screen the document literature brought into the article.The methodological quality of the included RCT was assessed by two reviewers independently.After studying the quality according to the scale of criteria for methodological quality Cochrane Reviewer Handbook 5.0.2, the meta-analysis was conducted. Results A total of 13 RCT involving 3 002 patients were included, and all of them quality were medium.The meta-analysis showed that FTS group compared with the traditional group, the time to first postoperative flatus and off-bed activity, as well as the initial lactation time were significant shorter.The quantity of 72 hours lactation increased.The bottom of the uterus after postpartum highly reduced.The healing time of incision shortened.The hospitalization time and cost were significant reduced.The postoperative morbidity were decreased(P<0.05). Conclusions Use of FTS in the setting of caesarean section is safe and effective, and it can also reduce the length of hospital stay and incidence of postoperative complications, and thereby accelerate postoperative recovery of the patients. Key words: Fast Track Surgery; Caesarean section; Meta-analysis

Fast-track surgery versus conventional perioperative management of lung cancer-associated pneumonectomy: a randomized controlled clinical trial

BackgroundThe aim of this study is to investigate the effects of fast-track surgery (FTS) on postoperative recovery, hospital stay, total medical costs, and the complications of pneumonectomy in patients with non-small cell lung cancer (NSCLC).MethodsStudies were performed between June 2012 and March 2014 in 17 patients received FTS and 18 patients given conventional management (control) after pneumonectomy in the Department of Thoracic Surgery, the Fourth Affiliated Hospital of Harbin Medical University. Patients were evaluated based on their days to achieve the first postoperative flatus, C-reactive protein (CRP) at postoperative day (POD) 1–7, the length of hospital stay, the medical costs, and postoperative complications.ResultsThe results showed that in the FTS group, latency to the first postoperative flatus (1.5 ± 0.6 versus 3.1 ± 0.8 s in controls, P < 0.0001), CRP (71.36 ± 5.48 versus 80.71 ± 8.32 mg/L in at POD 7, P < 0.0001), the length of hospital stay (18.1 ± 1.4 versus 27.4 ± 6.6 days, P < 0.0001), and the medical costs (29.9 ± 2.7 versus 37.2 ± 3.6 thousand Chinese Yuan, P < 0.0001) were significantly reduced compared to the group receiving conventional management. FTS group also had a relatively lower postoperative complication rate (23.5% of 17 versus 33.3% of 18 in control group) although it was statistically insignificant (P = 0.711).ConclusionsThese results indicate that application of the FTS in NSCLC pneumonectomy efficiently accelerates postoperative recovery, shortens hospital stay, reduces the total medical costs of the patients and thus is more acceptable than conventional management.

The effects of fast-track surgery on inflammation and immunity in patients undergoing colorectal surgery.

The objective of this study is to explore the effects of the fast-track surgery (FTS) program on inflammation and immunity in patients undergoing colorectal surgery. From August 2014 to March 2015, a prospective and randomized controlled trial of 230 patients who underwent colorectal surgery was performed. The patients were randomly assigned to an FTS group (116 patients) or a traditional group (114 patients). Inflammatory mediators, immunological indicators, postoperative recovery indexes, and complications were compared between the two groups. The inflammatory mediators (CRP, IL-6, TNF-α) were lower in the FTS group than in the traditional group (P < 0.05) on postoperative day (POD) 1, POD 4, and POD 6, and the immunological indicators (IgG, IgA, C3, C4) of the FTS group were superior to those of the traditional group (P < 0.05) on POD 4 and POD 6. The time to first aerofluxus, defecation, oral intake, and ambulation after surgery was shorter in the FTS group than in the traditional group (P < 0.05); however, the duration of postoperative hospitalization did not differ significantly between the two groups (P > 0.05). The total complications were significantly lower in the FTS group than in the traditional group (P < 0.05). The FTS program can decrease inflammation, maintain immune homeostasis, and improve rehabilitation effects in colorectal surgery patients.

Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial.

AimTo study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients.MethodsEighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21), FTS + laparotomy group (Group B, n=21), conventional perioperative care (CC) + laparoscopic group (Group C, n=21), and CC + laparotomy group (Group D, n=21). Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators.ResultsPreoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05). There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05). Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest.ConclusionFTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more effectively reduce postoperative stress reaction, and hence is safe and effective for elderly GC patients.

Effect and clinical significance of fast-track surgery combined with laparoscopic radical gastrectomy on the plasma level of vascular endothelial growth factor in gastric antrum cancer

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.

Fast-track surgery and exclusive enteral nutrition applied to a rat model of heterotopic intestinal transplantation.

The present study applied fast-track surgery (FTS) concepts and exclusive enteral nutrition (EEN) to a rat model of heterotopic intestinal transplantation (HIT). A total of 96 pairs of Sprague-Dawley rats were randomly distributed into three groups, as follows: i) The conventional group (group 1); ii) the FTS group (group 2); and iii) the FTS with EEN group (EEN group). FTS alterations to the HIT protocol were as follows: i) The use of sevoflurane as an anesthetic; ii) alterations to the order of the procedure and iii) a modified suturing technique. In addition, the EEN group rats underwent an early EEN gavage. The operation time, success rate, recovery state and morphological characteristics of the grafts were compared among the groups. The average operative time was significantly decreased in the group 2 and EEN group rats (137.44±16.03 and 139.67±15.25 min, respectively), as compared with the group 1 rats (169.36±13.72 min; P<0.05). In addition, the percentage of rats surviving >14 days was significantly increased in the group 2 (87.5%) and EEN group (90.6%) rats, as compared with the group 1 rats (68.7%; P<0.05). Furthermore, the villi of graft in EEN group appeared longer, and exhibited narrower interspaces. The ischemia-reperfusion injury and mononuclear cell infiltration were attenuated at postoperative day 7. The results of the present study suggested that the application of FTS concepts and EEN gavage to HIT may accelerate recovery and ameliorate graft damage following surgery.

Study of Fast Track Surgery in Patients with Biliary Intestinal Anastomosis in China

Objective: To investigate the feasibility. Safety and economical aspects of fast-track surgery (FTS) in patients with biliary intestinal anastomosis application security, effectiveness and its advantages. Methods: 31 patients were randomly divided into FTS group (n=16) and the control group (n=15). Control group using conventional perioperative treatment, guided by the idea of FTS group use the FTS perioperative measures, analysis and comparison of postoperative day 1 bad psychological emotions, exhaust and defecation time, postoperative hospitalization days and the hospitalization expenses and so on. Postoperative complications and adverse reactions in the groups. Results: Compared with the photographic, FTS group exhaust and defecation time in advance, and shorten hospitalization time, hospitalization expenses reduced (P 0.05). Conclusion: Fast- track surgery in patients with biliary intestinal anastomosis, with a safe, effective, economic and other characteristic, can accelerate the rehabilitation of patients.