Effects of enhanced recovery after surgery technique on stress indicators in patients undergoing laparoscopic rectal cancer surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Enlai , WANG Shuai , LIU Zhongze , YANG Hua ,  XIAO Weidong

Department of General Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R.China;

Corresponding author：

XIAO Weidong, Email: weidongxiao@126.com

Keywords：

enhanced recovery after surgery; rectal cancer; laparoscopic surgery; stress indicator; recovery

DOI：

10.7507/1007-9424.201701062

Video：

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Objective To observe effects of enhanced recovery after surgery (ERAS) technique on stress indicators in patients undergoing laparoscopic rectal cancer surgery. Methods One hundred and twenty patients underwent laparoscopic rectal cancer surgery (Dixon) in the Xinqiao Hospital of the Third Military Medical University were included in this study and then were randomly divided into an ERAS group (n=60) and a conventional treatment group (n=60). The patients in the ERAS group were treated with an ERAS concept during the perioperative period. The patients in the conventional treatment group were treated with a traditional treatment concept during the perioperative period. The stress indicators including white blood cell count (WBC) and C-reactive protein (CRP) and interleukin (IL)-6 levels were compared in the two groups at admission, 1 h before operation, and 24 h, 48 h, and 72 h after operation. The first postoperative anal exhaust time, the first postoperative defecation time, the total hospitalization time, and readmission rate were also recorded after operation. Results ① The age, gender, tumor diameter, and TNM stage had no significant differences in these two groups (P>0.05). ② There were no significant differences in the WBC, CRP and IL-6 levels at admission and 1 h before operation between the two groups (P>0.05). The levels of CRP, IL-6, and WBC in the ERAS group were significantly lower than those in the conventional treatment group at 24 h, 48 h and 72 h after operation (P<0.05). ③ The first postoperative anal exhaust time, the first postoperative defecation time, and the total hospitalization time in the ERAS group were significantly shorter than those in the conventional treatment group (P<0.05). There was no significant difference in readmission rate between the two groups (P<0.05). Conclusion ERAS concept is helpful in reducing stress response and could promote earlier recovery of patients with rectal cancer.

Citation： JIANG Enlai, WANG Shuai, LIU Zhongze, YANG Hua, XIAO Weidong. Effects of enhanced recovery after surgery technique on stress indicators in patients undergoing laparoscopic rectal cancer surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(8): 982-986. doi: 10.7507/1007-9424.201701062 Copy

1.	Kehlet H. Fast-track colorectal surgery. Lancet, 2008, 371(9615): 791-793.
2.	江志伟, 黎介寿. 快速康复外科—优化的临床路径. 中华胃肠外科杂志, 2012, 15(1): 12-13.
3.	黎介寿, 江志伟. 加速康复外科的临床意义不仅仅是缩短住院日. 中华消化外科杂志, 2015, 14(1): 22-24.
4.	朱德祥, 韦烨, 任黎. 促进术后恢复综合方案在结直肠癌根治术患者中的应用. 中华胃肠外科杂志, 2012, 15(6): 555-560.
5.	江志伟, 李宁. 结直肠手术应用加速康复外科中国专家共识(2015 版). 中华胃肠外科杂志, 2015, 18(8): 785-787.
6.	Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.
7.	Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
8.	Yang D, He W, Zhang S, et al. Fast-track surgery improves postoperative clinical recovery and immunity after elective surgery for colorectal carcinoma: randomized controlled clinical trial. World J Surg, 2012, 36(8): 1874-1880.
9.	江志伟, 黎介寿. 规范化开展加速康复外科几个关键问题. 中国实用外科杂志, 2016, 36(1): 44-46.
10.	Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, et al. Relationships among pain, anxiety, and depression in primary care. Depress Anxiety, 2008, 25(7): 593-600.
11.	Karakoyun-Celik O, Gorken I, Sahin S, et al. Depression and anxiety levels in woman under follow-up for breast cancer: relationship to coping with cancer and quality of life. Med Oncol, 2010, 27(1): 108-113.
12.	姜乾金. 医学心理学. 北京: 人民卫生出版社, 2010: 38-45.
13.	Max MB, Wu T, Atlas SJ, et al. A clinical genetic method to identify mechanisms by which pain causes depression and anxiety. Mol Pain, 2006, 2: 14.
14.	Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009, 144(10): 961-969.
15.	柳欣欣, 江志伟, 汪志明, 等. 加速康复外科在结直肠癌手术病人的应用研究. 肠外与肠内营养, 2007, 14(4): 205-208.
16.	Paton F, Chambers D, Wilson P, et al. Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis. BMJ Open, 2014, 4(7): e005015.
17.	中华医学会外科学分会腹腔镜与内镜外科学组. 3D 腹腔镜手术技术专家共识(2015). 中国实用外科杂志, 2015, 35(9): 967-969.
18.	Gustafsson UO, Hausel J, Thorell A, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg, 2011, 146(5): 571-577.
19.	宋开才, 王云海, 李涛, 等. 腹腔镜结直肠癌手术患者围手术期应用快速康复外科的系统评价. 中华胃肠外科杂志, 2012, 15(10): 1048-1052.
20.	Zhu Z, Wang C, Xu C, et al. Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial. Gastric Cancer, 2013, 16(2): 193-200.
21.	李宁. 加速康复外科治疗中的围手术期营养支持. 肠外与肠内营养, 2008, 15(2): 65-67.
22.	Wang G, Jiang ZW, Xu J, et al. Fast-track rehabilitation program is conventional care after colorectal resection: a randomized clinical trial. World J Gastroenterol, 2011, 17(5): 671-676.
23.	石学银, 邹最. 加速康复外科的麻醉管理. 中华消化外科杂志, 2015, 14(1): 38-42.
24.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
25.	Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg, 2011, 254(6): 868-875.

1. Kehlet H. Fast-track colorectal surgery. Lancet, 2008, 371(9615): 791-793.
2. 江志伟, 黎介寿. 快速康复外科—优化的临床路径. 中华胃肠外科杂志, 2012, 15(1): 12-13.
3. 黎介寿, 江志伟. 加速康复外科的临床意义不仅仅是缩短住院日. 中华消化外科杂志, 2015, 14(1): 22-24.
4. 朱德祥, 韦烨, 任黎. 促进术后恢复综合方案在结直肠癌根治术患者中的应用. 中华胃肠外科杂志, 2012, 15(6): 555-560.
5. 江志伟, 李宁. 结直肠手术应用加速康复外科中国专家共识(2015 版). 中华胃肠外科杂志, 2015, 18(8): 785-787.
6. Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.
7. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
8. Yang D, He W, Zhang S, et al. Fast-track surgery improves postoperative clinical recovery and immunity after elective surgery for colorectal carcinoma: randomized controlled clinical trial. World J Surg, 2012, 36(8): 1874-1880.
9. 江志伟, 黎介寿. 规范化开展加速康复外科几个关键问题. 中国实用外科杂志, 2016, 36(1): 44-46.
10. Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, et al. Relationships among pain, anxiety, and depression in primary care. Depress Anxiety, 2008, 25(7): 593-600.
11. Karakoyun-Celik O, Gorken I, Sahin S, et al. Depression and anxiety levels in woman under follow-up for breast cancer: relationship to coping with cancer and quality of life. Med Oncol, 2010, 27(1): 108-113.
12. 姜乾金. 医学心理学. 北京: 人民卫生出版社, 2010: 38-45.
13. Max MB, Wu T, Atlas SJ, et al. A clinical genetic method to identify mechanisms by which pain causes depression and anxiety. Mol Pain, 2006, 2: 14.
14. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009, 144(10): 961-969.
15. 柳欣欣, 江志伟, 汪志明, 等. 加速康复外科在结直肠癌手术病人的应用研究. 肠外与肠内营养, 2007, 14(4): 205-208.
16. Paton F, Chambers D, Wilson P, et al. Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis. BMJ Open, 2014, 4(7): e005015.
17. 中华医学会外科学分会腹腔镜与内镜外科学组. 3D 腹腔镜手术技术专家共识(2015). 中国实用外科杂志, 2015, 35(9): 967-969.
18. Gustafsson UO, Hausel J, Thorell A, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg, 2011, 146(5): 571-577.
19. 宋开才, 王云海, 李涛, 等. 腹腔镜结直肠癌手术患者围手术期应用快速康复外科的系统评价. 中华胃肠外科杂志, 2012, 15(10): 1048-1052.
20. Zhu Z, Wang C, Xu C, et al. Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial. Gastric Cancer, 2013, 16(2): 193-200.
21. 李宁. 加速康复外科治疗中的围手术期营养支持. 肠外与肠内营养, 2008, 15(2): 65-67.
22. Wang G, Jiang ZW, Xu J, et al. Fast-track rehabilitation program is conventional care after colorectal resection: a randomized clinical trial. World J Gastroenterol, 2011, 17(5): 671-676.
23. 石学银, 邹最. 加速康复外科的麻醉管理. 中华消化外科杂志, 2015, 14(1): 38-42.
24. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
25. Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg, 2011, 254(6): 868-875.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effects of enhanced recovery after surgery technique on stress indicators in patients undergoing laparoscopic rectal cancer surgery

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