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
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) … Show more
“…The outcome variables (postoperative hospital stay, duration to first flatus after surgery, hospitalization expenditure, and short-term complication) extracted from these studies are presented in Table 2 . Two studies did not report duration to first flatus after surgery, and three studies did not report hospital charge [ 15 , 17 , 18 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Only three studies reported duration to first flatus after surgery [ 14 , 16 , 17 ]. There was significant heterogeneity among the studies ( I 2 = 90%, P < 0.01).…”
BackgroundIt is still unclear whether enhanced recovery after surgery is effective and safe in laparoscopic gastrectomy for gastric carcinoma.MethodsCochrane library databases, Medline, Embase, and Pubmed were searched from January 1, 1986, to December 31, 2016. Randomized controlled trials (RCTs) comparing fast-track recovery with conventional recovery strategies in laparoscopic radical gastrectomy for gastric carcinoma were included. The main outcomes measured were postoperative hospital stay, time to first flatus, hospital charge, and overall complication rate.ResultsSix RCTs with 400 patients were included in this study. Fast-track surgery has shorter postoperative hospital stays (weighted mean difference (WMD) − 2.65; 95% CI, − 4.01 to − 1.29, z = 3.82, P < 0.01) and less hospitalization expenditure (WMD − 523.43; 95% CI, − 799.79 to − 247.06, z = 3.71, P < 0.01) than conventional recovery strategies. There was no significant difference with respect to duration to first flatus (WMD − 17.72; 95% CI, − 39.46–4.02, z = 1.60, P = 0.11) and complication rate (OR 1.57; 95% CI, 0.82–2.98, z = 1.37, P = 0.17).ConclusionsEnhanced recovery after surgery is effective and safe and is thus recommended in laparoscopic radical gastrectomy for gastric carcinoma.
“…The outcome variables (postoperative hospital stay, duration to first flatus after surgery, hospitalization expenditure, and short-term complication) extracted from these studies are presented in Table 2 . Two studies did not report duration to first flatus after surgery, and three studies did not report hospital charge [ 15 , 17 , 18 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Only three studies reported duration to first flatus after surgery [ 14 , 16 , 17 ]. There was significant heterogeneity among the studies ( I 2 = 90%, P < 0.01).…”
BackgroundIt is still unclear whether enhanced recovery after surgery is effective and safe in laparoscopic gastrectomy for gastric carcinoma.MethodsCochrane library databases, Medline, Embase, and Pubmed were searched from January 1, 1986, to December 31, 2016. Randomized controlled trials (RCTs) comparing fast-track recovery with conventional recovery strategies in laparoscopic radical gastrectomy for gastric carcinoma were included. The main outcomes measured were postoperative hospital stay, time to first flatus, hospital charge, and overall complication rate.ResultsSix RCTs with 400 patients were included in this study. Fast-track surgery has shorter postoperative hospital stays (weighted mean difference (WMD) − 2.65; 95% CI, − 4.01 to − 1.29, z = 3.82, P < 0.01) and less hospitalization expenditure (WMD − 523.43; 95% CI, − 799.79 to − 247.06, z = 3.71, P < 0.01) than conventional recovery strategies. There was no significant difference with respect to duration to first flatus (WMD − 17.72; 95% CI, − 39.46–4.02, z = 1.60, P = 0.11) and complication rate (OR 1.57; 95% CI, 0.82–2.98, z = 1.37, P = 0.17).ConclusionsEnhanced recovery after surgery is effective and safe and is thus recommended in laparoscopic radical gastrectomy for gastric carcinoma.
“…Elements of the ERAS pathways for different surgical subgroups are essentially the same with minor modifications. [1516171819202122232425262728293031323334353637383940414243444546474849] General elements include preoperative nutritional screening, no preoperative bowel preparation, maltodextrin drink 2 h before surgery, prophylactic antibiotics, epidural or patient-controlled analgesia, prokinetic agents, goal-directed fluid therapy, early mobilisation, predefined criteria for removal of drains, nasogastric tubes and catheters, immediate extubation, early oral intake and a specific discharge plan. Surgery-specific elements like octreotide for pancreaticoduodenectomies, minimal tissue handling and minimally invasive surgery for urogynaecological oncosurgery or pharmacological thromboprophylaxis for head and neck free-flap surgery are important.…”
Integrating perioperative medicine with anaesthesia is the need of the hour. Evolution of a new superspeciality called perioperative anaesthesia can improve surgical outcomes by quality perioperative care and guarantee imminent escalation of influence and power for anaesthesiologists. All original peer-reviewed manuscripts pertaining to surgery-specific perioperative surgical home models involving preoperative, intraoperative and postoperative initiatives spanning the past 5 years have been reviewed using PubMed and Google Scholar. Whether the perioperative surgical home model is feasible or still a distant dream in the Indian perspective has been analysed.
“…Given the strong evidence and recommendations for colorectal cancer, the application of ERAS protocols for gastrectomy procedures has been investigated in several studies[ 16 - 19 ]. ERAS principles combined with laparoscopic treatment for GC lead to satisfactory clinical outcomes[ 20 - 22 ], even in elderly patients[ 23 , 24 ]. Several meta-analyses have revealed that ERAS pathways in GC patients reduce the duration of hospital stay and medical costs without significantly increasing complications and hospital readmission[ 25 - 28 ], and the ERAS Society issued consensus guidelines for perioperative care after elective gastrectomy for GC in 2014[ 29 ].…”
AIMTo provide an updated assessment of the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in elective gastric cancer (GC) surgery.METHODSPubMed, Medline, EMBASE, World Health Organization International Trial Register, and Cochrane Library were searched up to June 2017 for all available randomized controlled trials (RCTs) comparing ERAS protocols and standard care (SC) in GC surgery. Thirteen RCTs, with a total of 1092 participants, were analyzed in this study, of whom 545 underwent ERAS protocols and 547 received SC treatment.RESULTSNo significant difference was observed between ERAS and control groups regarding total complications (P = 0.88), mortality (P = 0.50) and reoperation (P = 0.49). The incidence of pulmonary infection was significantly reduced (P = 0.03) following gastrectomy. However, the readmission rate after GC surgery nearly tripled under ERAS (P = 0.009). ERAS protocols significantly decreased the length of postoperative hospital stay (P < 0.00001) and medical costs (P < 0.00001), and accelerated bowel function recovery, as measured by earlier time to the first flatus (P = 0.0004) and the first defecation (P < 0.0001). Moreover, ERAS protocols were associated with a lower level of serum inflammatory response, higher serum albumin, and superior short-term quality of life (QOL).CONCLUSIONCollectively, ERAS results in accelerated convalescence, reduction of surgical stress and medical costs, improved nutritional status, and better QOL for GC patients. However, high-quality multicenter RCTs with large samples and long-term follow-up are needed to more precisely evaluate ERAS in radical gastrectomy.
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