Application value of enhanced recovery after surgery in totally Da Vinci robotic total gastrectomy / 中华消化外科杂志

ABSTRACT

Objective:To investigate the application value of enhanced recovery after surgery (ERAS) in totally Da Vinci robotic total gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 97 patients with gastric cancer who underwent totally Da Vinci robotic total gastrectomy in the First Affiliated Hospital of Nanchang University between January 2016 and February 2019 were collected.There were 57 males and 40 females, aged (59±10)years, with a range from 35 to 60 years. Of the 97 patients, 52 receiving perioperative management using ERAS were allocated into ERAS group, and 45 receiving traditional perioperative management were allocated into traditional group. Observation indicators (1) intraoperative situations; (2) postoperative situations. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers, and the chi-square test was used for comparison between groups. Repeated measurement data were analyzed by ANOVA. Comparison of ordinal datas was analyzed using the Mann-Whitney U test. Results:(1) Intraoperative situations patients in the ERAS group and traditional group underwent totally Da Vinci robotic total gastrectomy for gastric cancer successfully. Cases with Roux-en-Y anastomosis or uncut Roux-en-Y anastomosis (methods of digestive reconstruction), operation time, volume of intraoperative blood loss for the ERAS group were 25, 27, (205±28)minutes, (176±80)mL, respectively, versus 21, 24, (199±31)minutes, (182±81)mL for the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.02, t=1.00, 0.37, P>0.05). (2) Postoperative situations time to first out-of-bed activities, time to first anal flatus, time to initial liquid food intake, time to abdominal drainage tube removal, cases with postoperative complications, the number of lymph node dissected, cases in stage Ⅰ, Ⅱ, Ⅲ of postoperative tumor staging, duration of postoperative hospital stay, hospitalization expenses were (1.85±0.29)days, (2.90±0.47)days, (2.53±0.28)days, (5.72±0.95)days, 6, 28±8, 4, 25, 23, (6.43±0.52)days, (60 222±3 888)yuan in the ERAS group and (3.04±0.39)days, (3.82±0.36)days, (4.24±0.30)days, (6.75±0.48)days, 5, (27±6)days, 3, 20, 22, (8.47±0.69)days, (64 197±3 369)yuan in the traditional group, respectively. There were significant differences in the time to first out-of-bed activities, time to first anal flatus, time to initial liquid food intake, time to abdominal drainage tube removal, duration of postoperative hospital stay and hospitalization expenses between the two groups ( t=17.19, 10.69, 29.02, 6.58, 16.57, 5.34, P<0.05). There was no significant difference in the postoperative complications, the number of lymph node dissected, or postoperative tumor staging between the two groups ( χ2=0.01, t=0.68, Z=-0.46, P>0.05). From 2 hours after anesthesia awakening to 48 hours after surgery, the visual analog pain scores were changed from 3.06±0.29 to 2.13±0.32 in the ERAS group, and from 4.11±0.74 to 3.26±0.42 in the traditional group, respectively, showing a significant difference in the changing trend between the two groups ( F=264.45, P<0.05). There was no death or readmission in the postoperative 30 days. Conclusions:ERAS applied in the totally Da Vinci robotic total gastrectomy is safe and effective, which is associated with faster gastrointestinal function recovery, shorter hospital stay, better pain control, and quicker recovery afer surgery.