Background
To evaluate the immune function of gastric cancer patients after single-incision laparoscopic distal gastrectomy (SIDG) or multiport laparoscopic distal gastrectomy (MLDG) guided by enhanced recovery after surgery (ERAS).
Methods
A retrospective cohort study was performed on 120 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The patients were divided into two groups according to operation method: group A (MLDG) and group B (SIDG), both guided by ERAS concept. The indicators reflecting immune function and inflammation, such as CD3+, CD4+, CD8+ and NK cell count, CD4+/CD8+ cell ratios, IgA, IgM and IgG levels, C-reactive protein (CRP), total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) were tested 3 days and 7 days after surgery.
Results
The skin incision length of patients in group B was significantly shorter than that in group A, but the operation time was significantly longer in group B than that in group A (P < 0.05). There were no significant differences in preoperative CD3+, CD4+, CD8+, natural killer (NK) cells, CD4+/CD8+, IgA, IgM and IgG levels between two groups (P < 0.05). Three days after surgery, the immune function indices were decreased in both groups, but with no significant difference between two groups (P > 0.05). On the 7th day after surgery, the immune indexes of both groups recovered somewhat, approaching the preoperative level (P > 0.05). Inflammation indexes increased 3 days after surgery and decreased 7 days after surgery in both groups, among them the CRP level in group A was higher than that in group B (P < 0.05). The 3-year survival rate were 96.7% in group A and 91.7% in group B, respectively, with no statistically significant difference.
Conclusion
Compared with MLDG guided by ERAS, SIDG under the guidance of the ERAS concept has better cosmetic effect and similar effect on immune function of gastric cancer patients.
Purpose The aim of this study was to determine the risk of severe postoperative complications (SPCs) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients.Methods We retrospectively analyzed 297 consecutive patients undergoing gastrectomy in this multicenter study. Sarcopenia was diagnosed by preoperative computed tomography of the L3 skeletal muscle area. Nutritional status was assessed according to the Global Leadership Initiative on Malnutrition criteria. According to the Clavien–Dindo classification system, SPCs were classified as C-D Grade ≥ IIIa. A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs.Results Of the 297 patients analyzed in this study, 86 (28.96%) were diagnosed with malnutrition, 55 (18.52%) were diagnosed with sarcopenia, and 24 (8.08%) were diagnosed with SPCs. Patients who developed SPCs had longer hospital stays (SPCs vs. non-SPCs: 23 vs. 11 days, P < 0.001) and higher hospitalization expenses (SPCs vs. non-SPCs: 121456¥ vs. 72012¥, P < 0.001) than those who did not. Logistic analysis revealed that malnutrition (P < 0.001), sarcopenia (P = 0.017), combined resection (P = 0.028), and duodenostomy (P = 0.001) independently predicted the occurrence of SPCs. The nomogram exhibited good discrimination, with a discriminant consistency index of 0.822, and the calibration was also excellent.Conclusions Sarcopenia, malnutrition, combined resection and duodenostomy are independent predictors of SPCs. Our nomogram exhibited good discrimination and was practical for identifying patients at high risk of SPCs.
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