Observation of fast track surgery in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of fast track surgery on patients with gastric cancer in perioperative period.</p><p><b>METHODS</b>Ninety-two patients with gastric cancer undergone radical operations were randomly divided into two groups: fast track group (n=46, fast track surgery) and control group(n=46, traditional surgery). Serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C reaction protein (CRP) in the 92 patients were assayed preoperatively and at day 1, 3, 7 postoperatively, and the resting energy expenditure (REE) was also measured by indirect calorimetry in the morning. The postoperative hospital stay, duration of fever, medical cost, postoperative time of flatus and postoperative complications were recorded and compared respectively.</p><p><b>RESULTS</b>At postoperative day 1 and 3, serum levels of TNF-alpha were (12.67+/-2.68) fmmol/L and (13.19+/-2.75) fmmol/L in fast track group, (14.74+/-3.18) fmmol/L and (15.56+/-2.99) fmmol/L in control group; serum levels of IL-6 were (112.52+/-24.73) ng/L and (129.03+/-22.75) ng/L in fast track group, (123.90+/-22.52) ng/L and (142.67+/-20.33) ng/L in control group. The levels of IL-6 and TNF-alpha in fast track group were significantly lower than those in control group (all P<0.05). At postoperative day 1, 3 and 7, serum levels of CRP in fast track group were significantly lower than those in control group [d1(56.20+/-11.47) g/L vs (71.07+/-17.32) g/L, d3(136.09+/-19.78) g/L vs (157.78+/-28.18) g/L, d7 (48.53+/-12.95) g/L vs (64.72+/-19.73) g/L] (all P<0.05). At postoperative day 1 and day 3, the REE in fast track group were significantly lower those than in control group [d1(5713.96+/-619.44) kJ/d vs (6176.04+/-614.46) kJ/d, d3 (5298.49+/-639.36) kJ/d vs (5627.94+/-656.72) kJ/d] (all P<0.05). The postoperative duration of fever [2(2.0-3.0) d vs 4(2.8-4.0) d], postoperative time of flatus [3(2.0-4.0) d vs 4(3.8-5.0) d], postoperative hospital stay [6(6.0-7.0) d vs 8(7.0-8.3) d] and treatment expense [(27 201+/-3857) Chinese yuan vs (31 006+/-3555) Chinese yuan] in fast track group were also significantly lower than those in control group (P<0.01). There were no significant differences in complications between the two groups(P>0.05). The quality of life score on discharge in fast track group was significantly higher than that in control group (15.74+/-1.82 vs 14.67+/-1.27, P<0.01).</p><p><b>CONCLUSION</b>Fast track surgery can ameliorate stress reaction, decrease postoperative patients' REE during perioperative period and accelerate the rehabilitation of patients with gastric cancer.</p>

Effects of intensive insulin therapy on insulin resistance and serum proteins after radical gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of intensive insulin therapy on insulin resistance(IR) and serum proteins after radical gastrectomy.</p><p><b>METHODS</b>Twenty-two gastric cancer patients were randomly divided into the control (n=11) and intensive insulin therapy group (n=11), and underwent distal radical subtotal gastrectomy under epidural anesthesia. Fasting blood glucose (FBG), fasting insulin (FINS) and serum proteins were assayed preoperatively and at day 1, 3, 7 postoperatively. Insulin resistance index was calculated using homeostasis model assessment (HOMA). The length of hospital stay and postoperative complications were recorded respectively.</p><p><b>RESULTS</b>(1)The levels of FBG, FINS, lnHOMA-IR (P<0.01,P<0.05) and the incidence of insulin resistance were remarkably decreased by intensive insulin therapy after the surgical procedure.(2)The levels of serum transferrin (TRF), prealbumin (PRE) and retinal binding protein (RBP) in the intensive insulin therapy group were significantly improved as compared to control group after operation(P<0.05). (3) The duration of fever, antibiotic use, passage of gas by anus, length of hospital stay and the occurrence of postoperative complications were also significantly lower than those in control group(P<0.01,P<0.05).</p><p><b>CONCLUSION</b>Compared to routine therapy, the intensive insulin therapy has more beneficial effects on the patients undergone distal radical subtotal gastrectomy in decreasing the insulin resistance, improving the status of nutrition and preventing postoperative complications.</p>