Effects of enhanced recovery after surgery on postoperative intestinal function and intestinal flora during laparoscopic gastric cancer surgery

Figure 1 Shannon index changes during perioperative period. ^aP < 0.05. The Shannon index was similar between groups at baseline. After surgery, both groups showed decreased Shannon index values, but the enhanced recovery after surgery maintained significantly higher levels throughout the recovery period. The enhanced recovery after surgery also demonstrated faster recovery toward baseline values compared to the traditional treatment group. ERAS: Enhanced recovery after surgery.

Figure 2 Changes in probiotics during the perioperative period. Standard deviation for enhanced recovery after surgery: ± 0.58-0.89, standard deviation for traditional group: ± 0.57-0.77, all differences between groups are statistically significant except at preoperative timepoint. ERAS: Enhanced recovery after surgery.

Figure 3 Subgroup analysis of enhanced recovery after surgery protocol efficacy by age. ^aP < 0.05. The subgroup analysis revealed that enhanced recovery after surgery protocol significantly improved recovery in both age groups, with greater benefits observed in younger patients (≤ 61 years). Specifically, the enhanced recovery after surgery achieved earlier first flatus (22.15 hours vs 27.25 hours in ≤ 61 years; 25.75 hours vs 29.65 hours in > 61 years) and shorter postoperative hospital stay (5.8 days vs 7.9 days in ≤ 61 years; 6.6 days vs 8.3 days in > 61 years) compared to traditional treatment. A: Time to first flatus (hours); B: Postperative hospital stay (days).

Figure 4 Cox regression analysis of factors affecting intestinal flora diversity. The Cox regression analysis of postoperative intestinal flora diversity recovery shows that enhanced recovery after surgery protocol, high Shannon index, early oral intake, and operative time less than 240 minutes are protective factors (hazard ratio > 1), while advanced age, prolonged antibiotic use, and tumor-node-metastasis stage III are adverse factors (hazard ratio < 1). ERAP: Emergency Rental Assistance Program; TNM: Tumor-node-metastasis.