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Rosenberg KM, Blitzer DN, Rosenberger S, Chaudhary M, Sarkar R. Enhanced Recovery After Surgery Protocol Decreases Hospital Length of Stay and Post-Operative Opioid Use for Thoracic Outlet Syndrome Surgical Decompression. J Vasc Surg 2025:S0741-5214(25)01042-0. [PMID: 40378931 DOI: 10.1016/j.jvs.2025.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 05/02/2025] [Accepted: 05/05/2025] [Indexed: 05/19/2025]
Abstract
OBJECTIVE First rib resection for thoracic outlet syndrome (TOS) requires inpatient hospital stay and causes post-operative pain. We hypothesized that an enhanced recovery after surgery (ERAS) protocol, including multimodal pain management, would reduce post-operative narcotic use and length of stay (LOS). METHODS A retrospective single center case-control study (2016-2022) compared three protocols: 1) conventional peri-operative and pain management, 2) multimodal pain management with implantation of ropivacaine pump, and 3) ERAS peri-operative protocol including ropivacaine pump. Primary (inpatient opioid use and LOS) and secondary outcomes (complications and hospital cost) were assessed. RESULTS 98 patients were evaluated (107 first rib resections). Compared to conventional pain management (median 33 mg/d), daily opioid use significantly decreased with both multimodal pain management alone (14 mg/d, P<0.0001) and full ERAS protocol (11 mg/d, P<0.0001). ERAS patients had shorter LOS than conventional management (1.44 d vs. 3.26 d, P<0.0001), but multimodal pain management alone did not. Complication rates were similar among the three groups, although ERAS patients had increased post-operative ED visits (n=4 (7.4%) vs. n=7 (27%), P=0.024) and readmissions (n=2 (3.7%) vs. n=5 (19%), P=0.034). Index hospital admission cost decreased between the ERAS and conventional groups (mean: $9,327 vs. $13,053, P=0.012). Total hospital cost including ED visits and readmissions, however, was similar between the three protocols. CONCLUSIONS Consistent with other areas of surgery, ERAS yielded a >2-fold decrease in LOS, multimodal pain management alone decreased opioid use, but did not reduce LOS. ERAS protocol increased ED visits and readmissions, suggesting that optimization to decrease readmissions will improve care and lower costs.
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Affiliation(s)
- Kenneth M Rosenberg
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201.
| | - David N Blitzer
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201
| | - Sarah Rosenberger
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201
| | - Mirnal Chaudhary
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201
| | - Rajabrata Sarkar
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201.
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Aregui A, Estrada J, Lefèvre M, Carteaux-Taieb A, Beraud-Chaulet G, Hammel P, Fossey-Diaz V, Aparicio T. Geriatric Assessment and Management, Prehabilitation and Rehabilitation for Older Aldults with Non-Colorectal Digestive Cancers. Cancers (Basel) 2025; 17:1589. [PMID: 40361514 PMCID: PMC12071841 DOI: 10.3390/cancers17091589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Revised: 04/15/2025] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND The incidence of cancer in older patients is high, reaching 2.3 million world-wide in 2018 for patients aged over 80. Because the characteristics of this population make therapeutic choices difficult, co-management between geriatricians and other cancer specialists has gradually become essential. METHODS This narrative review aims to synthesize current data on the contribution of geriatric assessment in the management of elderly patients with non-colorectal digestive cancers. Oncogeriatric assessment is multi-domain, including the evaluation of co-morbidities, autonomy, nutrition, cognition, mood, and functional assessment. RESULTS Oncogeriatric parameters are predictive of mortality and adverse events. In the peri-operative phase of non-colorectal digestive cancer surgical management, geriatric management can assist in the decision-making process, identify frailties, and arrange a specific and personalized trimodal preoperative rehabilitation program, including nutritional management, adapted physical activity, and psychological care. Its aim is to limit the risks of confusion and of decompensation of comorbidities, mainly cardio-respiratory, which is associated with the highest morbidity in biliary-pancreatic surgery for older adults, facilitate recovery of previous autonomy when possible, and shorten hospital stay. For metastatic cancers, or during multimodal management, such as peri-operative chemotherapy for localized gastric cancers or pre-operative radio-chemotherapy for oesophageal or rectal cancers, specific assessment of the tolerance of chemotherapy is necessary. Neuropathic toxicity and chemobrain have a greater impact on elderly patients, with an increased loss of autonomy. Joint geriatric management can reduce the rate of grade 3-5 adverse effects of chemotherapy in particular and improve quality of life. CONCLUSIONS Co-management between geriatricians and other specialties should be encouraged wherever possible.
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Affiliation(s)
- Amélie Aregui
- Paris Nord Oncogeriatrics Coordination Unit, Bretonneau and Saint Louis Hospitals, AP-HP, 75018 Paris, France
| | - Janina Estrada
- Geriatric Out-Patient Unit, Bretonneau Hospital, AP-HP, 75018 Paris, France
| | - Madeleine Lefèvre
- Paris Nord Oncogeriatrics Coordination Unit, Bretonneau and Saint Louis Hospitals, AP-HP, 75018 Paris, France
| | - Anna Carteaux-Taieb
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital, AP-HP, 75010 Paris, France
| | - Geoffroy Beraud-Chaulet
- Geriatrics Departement, Paul Brousse Hospital, AP-HP, 94800 Villejuif, France
- Oncogériatric Department, Gustave Roussy Institut, 94800 Villejuif, France
| | - Pascal Hammel
- Medical Oncology Department, Paul Brousse Hospital, AP-HP, Université Paris Saclay, 94800 Villejuif, France
| | - Virginie Fossey-Diaz
- Paris Nord Oncogeriatrics Coordination Unit, Bretonneau and Saint Louis Hospitals, AP-HP, 75018 Paris, France
- Geriatrics Departement, Bretonneau Hospital, AP-HP, 75018 Paris, France
| | - Thomas Aparicio
- Gastroenterology Department, Saint Louis Hospital, AP-HP, Université Paris Cité, 75010 Paris, France
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Endo S, Higashida M, Fujiwara Y, Furuya K, Yano S, Okada T, Yoshimatsu K, Ueno T. Risk factors for postoperative pneumonia in older adults aged ≥ 80 years with gastric cancer. BMC Cancer 2025; 25:342. [PMID: 40001053 PMCID: PMC11854380 DOI: 10.1186/s12885-025-13723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 02/12/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND In Japan, the proportion of elderly gastric cancer patients is increasing. Although surgery in patients aged ≥ 80 years is relatively safe, postoperative pneumonia often occurs, reducing quality of life and being fatal. We retrospectively investigated the risk factors for pneumonia after gastrectomy in elderly patients at our hospital. METHODS Between 2010 and 2019, 113 patients aged ≥ 80 years underwent gastrectomy for gastric cancer at our hospital. Of these, 88 patients were retrospectively investigated, excluding 25 patients who did not receive sufficient postoperative follow-up. The diagnosis of pneumonia was based on chest CT findings. Univariate and multivariate analyzes for risk factors of pneumonia were performed using the Cox proportional hazards model. RESULTS The patients were aged 80-93 years (median 83 years) and consisted of 63 males and 25 females. The surgical procedures included distal gastrectomy in 54, total gastrectomy in 25, proximal gastrectomy in two, and local resection in seven. Postoperative pneumonia was observed in 38 patients. Seventeen of them died from pneumonia. The time to onset of pneumonia was 0.2-144.6 months (median 12.0 months), and the median observation period for patients without pneumonia was 38.8 months. Multivariate analysis revealed that age, Geriatric Nutritional Risk Index, respiratory history, and extent of gastrectomy (total vs. distal: hazard ratio 3.91, 95% confidence interval 1.69-9.02) were independent pneumonia factors. CONCLUSIONS In patients aged ≥ 80 years, age, low nutritional status, respiratory history, and total gastrectomy were risk factors for postoperative pneumonia.
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Affiliation(s)
- Shunji Endo
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan.
| | - Masaharu Higashida
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Yoshinori Fujiwara
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Kei Furuya
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Shuya Yano
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Toshimasa Okada
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Kazuhiko Yoshimatsu
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Tomio Ueno
- Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan
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Tian Q, Wang H, Guo T, Yao B, Liu Y, Zhu B. The efficacy and safety of enhanced recovery after surgery (ERAS) Program in laparoscopic distal gastrectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Med 2024; 56:2306194. [PMID: 38279689 PMCID: PMC10823895 DOI: 10.1080/07853890.2024.2306194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Although ERAS Program had some advantages in laparoscopic distal gastrectomy (LDG), its efficacy and safety remained unclear. We conducted a systematic review and meta-analysis to assess the efficacy and safety of the ERAS group and the traditional care (TC) group in LDG. METHODS Multiple databases were retrieved from 1 January 2000 to 30 April 2023. The risk ratio (RR), standardized mean difference (SMD) and their 95% confidence interval (CI) were used to estimate the results. RESULTS Our meta-analysis contained 17 randomized controlled trials (RCTs) studies, which comprised 1468 patients. Regarding efficacy, the ERAS group had significantly shorter postoperative time to first flatus (SMD = -1.29 [95% CI: -1.68, -0.90]), shorter time to first defecation (SMD = -1.26 [95% CI: -1.90, -0.61]), shorter hospital stays (SMD = -0.99 [95% CI: -1.34, -0.63]), and lower hospitalization costs (SMD = -1.17 [95% CI: -1.86, -0.48]) compared to the TC group. Furthermore, in the ERAS group, C-reactive protein levels were lower on postoperative days 1, 3 or 4, and 7; albumin levels were higher on postoperative days 3 or 4 and 7; and interleukin-6 levels were lower on postoperative days 1 and 3. Regarding safety, the overall postoperative complication rate was lower in the ERAS group (RR: 0.76 [95% CI: 0.60, 0.97]), but there was no significant difference in the individual postoperative complication rate. Other indicators were also not statistically significant. CONCLUSION The combination of ERAS Program with laparoscopy surgery was safe and effective for the perioperative management of patients with distal gastric cancer.
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Affiliation(s)
- Qihui Tian
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Hongying Wang
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Tianyu Guo
- Department of Hepatobiliary and Pancreatic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Bing Yao
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Yefu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Bo Zhu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
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Ma Y, Zhao X, Pan Y, Yang Y, Wang Y, Ge S. Early intravenous branched-chain amino acid-enriched nutrition supplementation in older patients undergoing gastric surgery: a randomized clinical trial. Nutr J 2024; 23:137. [PMID: 39501291 PMCID: PMC11536675 DOI: 10.1186/s12937-024-01041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 10/30/2024] [Indexed: 11/09/2024] Open
Abstract
BACKGROUND The initiation time and formula for supplemental parenteral nutrition after surgery require optimization, especially in older patients undergoing major gastrointestinal surgery. This study aimed to assess the effect of early supplementation with a branched-chain amino acid (BCAA)-enriched formula (BAF) on short-term postoperative outcomes in older patients undergoing gastric surgery. METHODS This single-center, prospective, double-blinded, randomized clinical trial was conducted from March 10, 2020, to September 15, 2022. Patients aged 65-80 years with gastric cancer scheduled for curative resection were assessed for eligibility and randomly allocated to a high-proportion BCAA (HBCAA) (early supplementation with the BAF) or control (routine nutrition) group. The primary outcome was the standardized length of hospital stay (LOS). RESULTS A total of 150 patients were randomized. Thirteen patients were excluded due to the resection of other organs, presence of metastasis, or withdrawal of consent. Finally, we included 70 and 67 patients in the HBCAA and control groups, respectively (mean age: 70.5 ± 4.2 years; 96 men [70.1%]). The standardized LOS was significantly shorter in the treatment group than in the control group (median [interquartile range]: 8.0 [7.8, 8.0] vs. 8.5 [8.0, 9.0] days; mean difference, 0.38; 95% confidence interval [CI], 0.02-0.74 days; P < .001). Patients in the HBCAA group showed better gastrointestinal function with faster defecation (4.0 [3.6, 5.0] vs. 5.0 [4.0, 5.5] days; mean difference, 0.6 days; 95% CI, 0.26-0.94 days; P < .001) and semi-liquid diet initiation (8.0 [7.5, 8.0] vs. 8.0 [8.0, 8.8] days; mean difference, 0.36 days; 95% CI, 0.03-0.7 days; P < .001) and had lesser weight loss at postoperative day 5 than those in the control group did (3.5 [2.7, 6.5] vs. 4.9 [3.3, 7.6]%; mean difference, 1.23%; 95% CI, 0.27-2.19%; P = .011). CONCLUSIONS In this randomized clinical trial, compared with routine nutrition, early supplementation with a BAF was associated with a shorter standardized LOS in older patients undergoing gastric surgery, suggesting that it may be a favorable strategy for patients with a poor tolerance to external nutrition who are undergoing major surgery. TRIAL REGISTRATION ClinicalTrials.gov; Identifier: ChiCTR2000029635.
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Affiliation(s)
- Yimei Ma
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xining Zhao
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yan Pan
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yuying Yang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ying Wang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Shengjin Ge
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
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Isah AD, Shaibu Z, Dang SC. Optimizing postsurgical recovery for elderly patients with gastric cancer. World J Clin Oncol 2024; 15:1122-1125. [PMID: 39351454 PMCID: PMC11438840 DOI: 10.5306/wjco.v15.i9.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/07/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
Based on a recent study by Li et al, this editorial examines the significance of enhanced recovery after surgery (ERAS) protocols for elderly patients with gastric cancer. Cancer-related mortality, which is overwhelmingly caused by gastric cancer, calls for effective treatment strategies. Despite advances in the field of oncology, conventional postoperative care often results in prolonged hospital stays and increased complications. The aim of ERAS is to expedite recovery, reduce surgical stress, and improve patient satisfaction. The study of Li et al showed that, compared to traditional care, ERAS significantly reduces mortality risk, shortens hospital stays, and decreases postoperative complications. These findings support the widespread implementation of ERAS protocols in surgical practice to enhance patient outcomes and healthcare value.
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Affiliation(s)
- Adamu D Isah
- Department of Radiation Oncology, Institute of Oncology, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
- School of Medicine, Jiangsu University, Zhenjiang 202013, Jiangsu Province, China
| | - Zakari Shaibu
- School of Medicine, Jiangsu University, Zhenjiang 202013, Jiangsu Province, China
| | - Sheng-Chun Dang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
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Guo R, Yang WW, Zhong ML, Rao PG, Luo X, Liao BZ, Lei XH, Ye JM. The relationship between anesthesia, surgery and postoperative immune function in cancer patients: a review. Front Immunol 2024; 15:1441020. [PMID: 39295870 PMCID: PMC11408194 DOI: 10.3389/fimmu.2024.1441020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/21/2024] [Indexed: 09/21/2024] Open
Abstract
This review comprehensively examines the impact of anesthesia and surgical interventions on the immune function of cancer patients postoperatively. Recent studies have shown that surgery and its accompanying anesthesia management can significantly influence immune function in cancer patients, potentially affecting their prognosis. This review synthesizes clinical studies and basic research to summarize the specific effects of anesthesia methods, drugs, postoperative analgesia, intraoperative transfusion, surgical techniques, and trauma extent on the immune function of cancer patients post-surgery. Additionally, this review discusses optimization strategies based on current research, aiming to refine anesthesia and surgical management to maximize the preservation and enhancement of postoperative immune function in cancer patients, with the potential to improve clinical outcomes.
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Affiliation(s)
- Rui Guo
- Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Wen-Wen Yang
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Mao-Lin Zhong
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Pan-Guo Rao
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xin Luo
- Gannan Medical University, Ganzhou, Jiangxi, China
| | | | | | - Jun-Ming Ye
- Gannan Medical University, Ganzhou, Jiangxi, China
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Keller DS, Curtis N, Burt HA, Ammirati CA, Collings AT, Polk HC, Carrano FM, Antoniou SA, Hanna N, Piotet LM, Hill S, Cuijpers ACM, Tejedor P, Milone M, Andriopoulou E, Kontovounisios C, Leeds IL, Awad ZT, Barber MW, Al-Mansour M, Nassif G, West MA, Pryor AD, Carli F, Demartines N, Bouvy ND, Passera R, Arezzo A, Francis N. EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults. Surg Endosc 2024; 38:4104-4126. [PMID: 38942944 PMCID: PMC11289045 DOI: 10.1007/s00464-024-10977-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. METHODS Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology. RESULT Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery. CONCLUSIONS MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.
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Affiliation(s)
- Deborah S Keller
- Department of Digestive Surgery, University of Strasbourg, Strasbourg, FR, USA
| | - Nathan Curtis
- Surgical Unit, Dorset County Hospital, Dorchester, Dorset, UK
| | | | | | - Amelia T Collings
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hiram C Polk
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Francesco Maria Carrano
- Department of General and Minimally Invasive Surgery, Busto Arsizio Circolo Hospital, ASST-Valle Olona, Varese, Italy
| | - Stavros A Antoniou
- Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nader Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Sarah Hill
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia Tejedor
- Department of Colorectal Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marco Milone
- Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples "Federico II", Via Pansini 5, Naples, Italy
| | - Eleni Andriopoulou
- Department of Surgery, Hellenic Red Cross Korgialeneio Benakeio NHS, Athens, Greece
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus and the Royal Marsden Hospital, London, UK
| | - Ira L Leeds
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Meghan Wandtke Barber
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mazen Al-Mansour
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - George Nassif
- Department of Colorectal Surgery, AdventHealth, Orlando, FL, USA
| | - Malcolm A West
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
- Complex Cancer and Exenterative Service, University Hospitals Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton, Southampton, UK
| | - Aurora D Pryor
- Long Island Jewish Medical Center and System Chief for Bariatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA
| | - Franco Carli
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Nicole D Bouvy
- Innovative Surgical Techniques, Endoscopic and Endocrine Surgery, Department of Surgery, Maastricht University Medical Center, Amsterdam, Netherlands
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Nader Francis
- Department of Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK.
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Tankel J, Sticca G, Kammili A, Dehghani M, Sakalla R, Ahmed N, Meng A, Najmeh S, Spicer J, Cools-Lartigue J, Ferri L, Mueller C. ERAS following Gastrectomy for Octo- and Nonagenarians: A Single-Center Retrospective Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:484-489. [PMID: 38770682 DOI: 10.1089/lap.2024.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background: The safety and efficacy of enhanced recovery after surgery (ERAS) following elective gastrectomy for gastric cancer in patients >80 years of age are not well described. The aim of this study was to explore whether an ERAS protocol following gastrectomy in this age group can be safely implemented and reduce postoperative length of stay. Methods: A retrospective, single-center analysis was performed. All patients >80 years of age with gastric cancer undergoing elective subtotal and total gastrectomy between January 2010 and December 2021 were identified. With the implementation of an ERAS protocol in January 2016, patients treated beforehand were allocated to Group A (pre-ERAS) and Group B (ERAS). The length of stay, incidence of postoperative complications and representation/readmission to the hospital were compared between the groups. Results: Of the 221 patients identified, 56 met the inclusion criteria with 22 patients (39.3%) allocated to Group A and 34 patients (60.7%) to Group B. There were no differences with regard to the type of resection and surgical approach. Length of stay was shorter in Group B (5 days, range 2-27 versus 10 days, 3-109, P = .040). A trend toward more discharges by postoperative day 3 was noted among patients in Group B (7/34, 20.6% versus 2/22, 9.1%, P = .253). There were no differences in the incidence of postoperative complications or readmission hospital between the groups. Conclusion: Among patients >80 years of age, ERAS following gastrectomy for cancer is associated with a reduced length of stay and can be safely implemented.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Giancarlo Sticca
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Anitha Kammili
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Mehrnoush Dehghani
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Rawan Sakalla
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Nabeel Ahmed
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Andrew Meng
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Sara Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
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10
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Canzan F, Longhini J, Caliaro A, Cavada ML, Mezzalira E, Paiella S, Ambrosi E. The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: a systematic review and meta-analysis of randomized clinical trials. Front Nutr 2024; 11:1369141. [PMID: 38818132 PMCID: PMC11137291 DOI: 10.3389/fnut.2024.1369141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND AIMS Postoperative ileus is a frequent condition, leading to complications and a longer hospital stay. Few studies have demonstrated the benefit of early oral feeding in preventing ileus after gastrointestinal surgery. This study aims to evaluate the efficacy of early versus delayed oral feeding on the recovery of intestinal motility, length of hospital stay, and complications. METHODS We conducted a systematic review and meta-analysis of randomized control trials, searching PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and the ClincalTrials.gov until 31 December 2022. We evaluated the first passage of the stool, the first flatus, complications, length of postoperative stay, and vomiting. We assessed the risk of bias using the Cochrane risk of bias tool (version 2) for randomized trials and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation methodology. RESULTS We included 34 studies with a median sample size of 102 participants. With a moderate certainty of the evidence, the early oral feeding may reduce the time taken for the first passage of the stool (MD -0.99 days; CI 95% -1.25, -0.72), the first flatus (MD -0.70 days; CI 95% -0.87, -0.53), and the risk of complications (RR 0.69; CI 95% 0.59-0.80), while with a low certainty of evidence, it may reduce the length of stay (MD -1.31 days; CI 95% -1.59, -1.03). However, early feeding likely does not affect the risk of vomiting (RR 0.90; CI 95% 0.68, 1.18). CONCLUSION This review suggests that early oral feeding after gastrointestinal surgery may lead to a faster intestinal recovery, shorter postoperative stays, and fewer complications. However, careful interpretation is needed due to high heterogeneity and the moderate-to-low quality of evidence. Future studies should focus on the type and starting time of early oral feeding.
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Affiliation(s)
- Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jessica Longhini
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Arianna Caliaro
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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11
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Wang Q, Shen K, Fei B, Wei M, Ge X, Xie Z. Development and validation of a nomogram to predict cancer-specific survival of elderly patients with unresected gastric cancer who received chemotherapy. Sci Rep 2024; 14:9008. [PMID: 38637579 PMCID: PMC11026516 DOI: 10.1038/s41598-024-59516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
This investigation aimed to explore the prognostic factors in elderly patients with unresected gastric cancer (GC) who have received chemotherapy and to develop a nomogram for predicting their cancer-specific survival (CSS). Elderly gastric cancer patients who have received chemotherapy but no surgery in the Surveillance, Epidemiology, and End Results Database between 2004 and 2015 were included in this study. Cox analyses were conducted to identify prognostic factors, leading to the formulation of a nomogram. The nomogram was validated using receiver operating characteristic (ROC) and calibration curves. The findings elucidated six prognostic factors encompassing grade, histology, M stage, radiotherapy, tumor size, and T stage, culminating in the development of a nomogram. The ROC curve indicated that the area under curve of the nomogram used to predict CSS for 3, 4, and 5 years in the training queue as 0.689, 0.708, and 0.731, and in the validation queue, as 0.666, 0.693, and 0.708. The calibration curve indicated a high degree of consistency between actual and predicted CSS for 3, 4, and 5 years. This nomogram created to predict the CSS of elderly patients with unresected GC who have received chemotherapy could significantly enhance treatment accuracy.
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Affiliation(s)
- Qi Wang
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Kexin Shen
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bingyuan Fei
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mengqiang Wei
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xinbin Ge
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongshi Xie
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
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Li ZW, Luo XJ, Liu F, Liu XR, Shu XP, Tong Y, Lv Q, Liu XY, Zhang W, Peng D. Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients? World J Gastrointest Oncol 2024; 16:1334-1343. [PMID: 38660659 PMCID: PMC11037074 DOI: 10.4251/wjgo.v16.i4.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery (ERAS) in elderly patients with gastric cancer (GC). AIM To evaluate the safety of ERAS in elderly patients with GC. METHODS The PubMed, EMBASE, and Cochrane Library databases were used to search for eligible studies from inception to April 1, 2023. The mean difference (MD), odds ratio (OR) and 95% confidence interval (95%CI) were pooled for analysis. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores. We used Stata (V.16.0) software for data analysis. RESULTS This study consists of six studies involving 878 elderly patients. By analyzing the clinical outcomes, we found that the ERAS group had shorter postoperative hospital stays (MD = -0.51, I2 = 0.00%, 95%CI = -0.72 to -0.30, P = 0.00); earlier times to first flatus (defecation; MD = -0.30, I² = 0.00%, 95%CI = -0.55 to -0.06, P = 0.02); less intestinal obstruction (OR = 3.24, I2 = 0.00%, 95%CI = 1.07 to 9.78, P = 0.04); less nausea and vomiting (OR = 4.07, I2 = 0.00%, 95%CI = 1.29 to 12.84, P = 0.02); and less gastric retention (OR = 5.69, I2 = 2.46%, 95%CI = 2.00 to 16.20, P = 0.00). Our results showed that the conventional group had a greater mortality rate than the ERAS group (OR = 0.24, I2 = 0.00%, 95%CI = 0.07 to 0.84, P = 0.03). However, there was no statistically significant difference in major complications between the ERAS group and the conventional group (OR = 0.67, I2 = 0.00%, 95%CI = 0.38 to 1.18, P = 0.16). CONCLUSION Compared to those with conventional recovery, elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.
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Affiliation(s)
- Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao-Juan Luo
- Department of Endoscopy Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400012, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin-Peng Shu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yue Tong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Paredero-Pérez I, Jimenez-Fonseca P, Cano JM, Arrazubi V, Carmona-Bayonas A, Covela-Rúa M, Fernández-Montes A, Martín-Richard M, Gironés-Sarrió R. State of the scientific evidence and recommendations for the management of older patients with gastric cancer. J Geriatr Oncol 2024; 15:101657. [PMID: 37957106 DOI: 10.1016/j.jgo.2023.101657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Gastric cancer is one of the most frequent and deadly tumours worldwide. However, the evidence that currently exists for the treatment of older adults is limited and is derived mainly from clinical trials in which older patients are poorly represented. In this article, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Group for the Treatment of Digestive Tumours (TTD), and the Spanish Multidisciplinary Group on Digestive Cancer (GEMCAD) reviews the existing scientific evidence for older patients (≥65 years old) with gastric cancer and establishes a series of recommendations that allow optimization of management during all phases of the disease. Geriatric assessment (GA) and a multidisciplinary approach should be fundamental parts of the process. In early stages, endoscopic submucosal resection or laparoscopic gastrectomy is recommended depending on the stage. In locally advanced stage, the tolerability of triplet regimens has been established; however, as in the metastatic stage, platinum- and fluoropyrimidine-based regimens with the possibility of lower dose intensity are recommended resulting in similar efficacy. Likewise, the administration of trastuzumab, ramucirumab and immunotherapy for unresectable metastatic or locally advanced disease is safe. Supportive treatment acquires special importance in a population with different life expectancies than at a younger age. It is essential to consider the general state of the patient and the psychosocial dimension.
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Affiliation(s)
- Irene Paredero-Pérez
- Lluís Alcanyís de Játiva Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
| | - Paula Jimenez-Fonseca
- Asturias Central University Hospital (HUCA), Health Research Institute of the Principality of Asturias (ISPA), Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD), Oviedo, Spain
| | - Juana María Cano
- Ciudad Real University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Ciudad Real, Spain.
| | - Virginia Arrazubi
- Navarra University Hospital, Navarra Institute for Health Research (IdiSNA), Spanish Society of Medical Oncology (SEOM), Pamplona, Spain
| | - Alberto Carmona-Bayonas
- IMIB Morales Meseguer University Hospital, Murcia University (UMU), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Murcia, Spain
| | - Marta Covela-Rúa
- Lucus Agusti University Hospital (HULA), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Lugo, Spain
| | - Ana Fernández-Montes
- Ourense University Hospital Complex (CHUO), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Orense, Spain
| | - Marta Martín-Richard
- Institut Català d'Oncologia (ICO) - Duran i Reynals University Hospital, Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD), Barcelona, Spain.
| | - Regina Gironés-Sarrió
- Polytechnic la Fe University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
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Sun Y, Tian Y, Cao S, Li L, Yu W, Ding Y, Wang X, Kong Y, Wang X, Wang H, Hui X, Qu J, Wang H, Duan Q, Yang D, Zhang H, Zhou S, Liu X, Li Z, Meng C, Kehlet H, Zhou Y. Multimodal prehabilitation to improve the clinical outcomes of frail elderly patients with gastric cancer: a study protocol for a multicentre randomised controlled trial (GISSG +2201). BMJ Open 2023; 13:e071714. [PMID: 37816552 PMCID: PMC10565164 DOI: 10.1136/bmjopen-2023-071714] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Gastric cancer (GC) diagnosed in the elderly population has become a serious public health problem worldwide. Given the combined effects of frailty and the consequences of cancer treatment, older individuals with GC are more likely than young patients to suffer from postoperative complications and poor clinical outcomes. Nutrition, functional capacity and psychological state-based multimodal prehabilitation, which is dominated by Enhanced Recovery After Surgery (ERAS) pathway management, has been shown to reduce postoperative complications, promote functional recovery and decrease hospitalisation time in certain malignancies. However, no previous studies have investigated the clinical application of multimodal prehabilitation in frail older patients with GC. METHODS AND ANALYSIS The study is a prospective, multicentre randomised controlled trial in which a total of 368 participants who meet the inclusion criteria will be randomised into either a prehabilitation group or an ERAS group. The prehabilitation group will receive multimodal prehabilitation combined with ERAS at least 2 weeks before the gastrectomy is performed, including physical and respiratory training, nutritional support, and therapy and psychosocial treatment. The ERAS group patients will be treated according to the ERAS pathway. All interventions will be supervised by family members. The primary outcome measures are the incidence and severity of postoperative complications. Secondary outcomes include survival, functional capacity and other short-term postoperative outcomes. Overall, the multimodal prehabilitation protocol may improve functional capacity, reduce the surgical stress response and concomitant systemic inflammation, and potentially modulate the tumour microenvironment to improve short-term and long-term clinical outcomes and patients' quality of life. ETHICS AND DISSEMINATION All procedures and participating centres of this study were approved by their respective ethics committees (QYFYKYLL 916111920). The final study results will be published separately in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05352802.
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Affiliation(s)
- Yuqi Sun
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yulong Tian
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shougen Cao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Wenbin Yu
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yinlu Ding
- Department of Gastrointestinal Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Xixun Wang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Ying Kong
- Department of Gastrointestinal Surgery, Jining No.1 People's Hospital, Jining, China
| | - Xinjian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Wang
- Department of General Surgery, Dongying People's Hospital, Dongying, China
| | - Xizeng Hui
- Department of General Surgery, Rizhao People's Hospital, Rizhao, China
| | - Jianjun Qu
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - HongBo Wang
- Department of Gastrointestinal Surgery, People's Hospital of Jimo District, Qingdao, People's Republic of China
| | - Quanhong Duan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Daogui Yang
- Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Shaofei Zhou
- Department of Gastrointestinal Surgery, Qingdao Municipal Hospital Group, Qingdao, China
| | - Xiaodong Liu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zequn Li
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Meng
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet Copenhagen University, Denmark, UK
| | - Yanbing Zhou
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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15
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Klingbeil KD, Mederos M, Park JY, Seo YJ, Markovic D, Chui V, Girgis M, Kadera BE. Laparoscopic compared to open approach for distal gastrectomy may reduce pneumonia risk for patients with gastric cancer. Surg Open Sci 2023; 14:68-74. [PMID: 37533882 PMCID: PMC10392601 DOI: 10.1016/j.sopen.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
Background Whether laparoscopic approach to gastrectomy for gastric cancer (GC) reduces the risk of pneumonia remains unknown. In this study, we compared pneumonia outcomes for patients with GC who underwent either laparoscopic gastrectomy (LG) or open gastrectomy (OG). Methods The ACS NSQIP database was queried to identify patients with GC who underwent LG or OG between Jan 2012 - Dec 2018. Outcomes were compared using regression models. A post-hoc analysis was performed for elderly patients. Results The study cohort included 2661 patients, 23.4 % undergoing LG. Laparoscopic approach lowered pneumonia risk (OR 0.47, p = .028) and reduced hospital length of stay, (5.3 vs 7.1 days, p < .001). Elderly patients undergoing LG demonstrated similar benefits. Risk factors for pneumonia included advanced age, dyspnea and weight-loss, whereas laparoscopic approach reduced this risk. Conclusions LG in patients with GC has both statistically and clinically significant advantages over OG with respect to pneumonia. Further studies are needed to validate the relationship between postoperative pneumonia and surgical approach for gastrectomy.
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Affiliation(s)
- Kyle D. Klingbeil
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Mederos
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Joon Y. Park
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Young-Ji Seo
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Daniela Markovic
- Department of Medicine, Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Victor Chui
- Department of Medicine, Division of Hematology and Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mark Girgis
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Brian E. Kadera
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Wei XN, Cai WY, Wu KL, Zeng FG. Application effect of gastrointestinal bundle nursing on the protection of gastrointestinal function in patients with gastric cancer. Medicine (Baltimore) 2023; 102:e34308. [PMID: 37478274 PMCID: PMC10662839 DOI: 10.1097/md.0000000000034308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
Evidence-based nursing practice was used to formulate the enhanced recovery surgery bundle nursing strategy and apply it to patients with gastric cancer, to explore its safety, effectiveness and feasibility in perioperative gastrointestinal function protection in patients with gastric cancer. Selected the clinical medical records of 100 gastric cancer patients treated in our hospital from June 2019 to June 2021 as the research objects, and divided them into the control group and the observation group with 50 cases in each group according to the random number table. Among them, the control group was given routine nursing measures for nursing intervention, and the observation group was given gastrointestinal enhanced recovery surgery cluster nursing on the basis of the control group. The differences in stress response, gastrointestinal function protection, negative emotions and pain scores of gastric cancer patients before and after nursing were compared between the 2 groups. The postoperative bowel sounds recovery time, first anal exhaust, and first defecation time in the observation group were lower than those in the control group, and the differences were statistically significant (P < .05). Before nursing, there was no significant difference in the scores of stress response changes between the 2 groups (P > .05). After nursing, heart rate (HR), mean arterial pressure (MAP), norepinephrine (NE), and epinephrine (E2) in the observation group were lower than those in the control group, and the difference was statistically significant (P < .05). The pain scores of the 2 groups were significantly improved at different time points, and the observation group was significantly less than the control group, and the difference was statistically significant (P < .05). Gastrointestinal enhanced recovery surgery bundle nursing can effectively improve the gastrointestinal function of patients with gastric cancer, improve the emotional response and stress response of patients, and has certain reference value for the nursing of patients with gastric cancer.
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Affiliation(s)
- Xiao-Ning Wei
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Wen-Yan Cai
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kai-Ling Wu
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Fei-Ge Zeng
- Department of Urology Surgery, the first affiliated hospital of Hainan Medical University, Haikou, Hainan, China
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Sun Y, Li Z, Tian Y, Gao C, Liang B, Cao S, Liu X, Liu X, Meng C, Xu J, Yang H, Zhou Y. Development and validation of nomograms for predicting overall survival and cancer-specific survival in elderly patients with locally advanced gastric cancer: a population-based study. BMC Gastroenterol 2023; 23:117. [PMID: 37041468 PMCID: PMC10091668 DOI: 10.1186/s12876-023-02749-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE To evaluate the multiple factors influencing the survival of elderly patients with locally advanced gastric cancer (LAGC) and develop and validate the novel nomograms for predicting the survival. METHODS The clinical features of patients treated between 2000 and 2018 were collected and collated from the Surveillance, Epidemiology, and End Results (SEER) database and three medical centres in China, and the patients were randomly divided into a training cohort (3494), internal validation cohort (1497) and external validation cohort (841). Univariate and multivariate analyses of the prognostic values were performed to identify independent prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS), and two nomogram models were developed. Harrell's concordance index (C-index) and calibration curves were employed to assess discrimination and calibration. Decision curve analysis (DCA) and receiver-operating characteristic (ROC) curves were utilized to investigate the clinical usefulness. RESULTS In the SEER database, the 5-year OS of the patients was 31.08%, while the 5-year CSS of the patients was 44.09%. Furthermore, in the external validation set, the 5-year OS of the patients was 49.58%, and the 5-year CSS of these patients was 53.51%. After statistical analysis, nine independent prognostic factors of OS and CSS were identified, including age, race, tumour size, differentiation, TNM stage, gastrectomy type, lymph node metastasis (LNM), lymph node ratio (LNR) and chemotherapy. The C-index (approximately 0.7) and calibration curve (close to the optimal calibration line) indicated satisfactory discrimination and calibration of the nomogram. DCA and ROC curves showed that the developed nomogram was superior to TNM stage. CONCLUSION The novel validated nomogram could accurately predict the prognosis of individual elderly patients with LAGC and guide the selection of clinical treatment measures.
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Affiliation(s)
- Yuqi Sun
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Zequn Li
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yulong Tian
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Chao Gao
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Benjia Liang
- Shandong Provincial Hospital, Jinan, Shandong Province, China
| | - Shougen Cao
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiaodong Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuechao Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Cheng Meng
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Jianfei Xu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Hao Yang
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yanbing Zhou
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
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Jin H, Song S, Lu T, Ma S, Wang Y, Fu L, Zhang G, Han X, Zhang L, Yang K, Cai H. The application of enhanced recovery after surgery in minimally invasive gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials. Expert Rev Gastroenterol Hepatol 2022; 16:1089-1100. [PMID: 36354134 DOI: 10.1080/17474124.2022.2145944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We aimed to investigate the efficacy and safety of enhanced recovery after surgery (ERAS) for patients with gastric cancer undergoing minimally invasive surgery (MIS). METHODS We searched the PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, WanFang, and CBM for relevant RCTs from the database inception until December 2021, for studies that compared the ERAS and traditional care (TC) in MIS for gastric cancer. RESULTS A total of 25 RCTs comprising 2809 patients were included in this study. When compared with the traditional care TC group, the ERAS group had a shorter postoperative hospital stay [MD = -1.88,95%CI (-2.22, -1.55), P < 0.00001] and an earlier time at first postoperative flatus [MD = -18.12,95%CI (-21.45,-14.80), P < 0.00001] along with lower medical costs [SMD = -0.64, 95% CI (-0.85, -0.43), P < 0.00001] and an overall reduction in postoperative complication rates [RR = 0.55, 95% CI (0.44, 0.69), P < 0.00001]. However, the difference in the readmission rates was not significant. CONCLUSIONS ERAS can shorten the postoperative hospital stay, hasten the first postoperative flatus and reduce medical costs and overall postoperative complication rate without increasing readmission rates. Therefore, the ERAS protocol is preferable for gastric cancer patients undergoing MIS.
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Affiliation(s)
- Haojie Jin
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China.,Institution of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, China.,General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China.,Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
| | - Shaoming Song
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China.,Institution of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, China.,General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Tingting Lu
- Institution of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Shixun Ma
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China.,Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
| | - Yongfeng Wang
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China.,Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
| | - Liangyin Fu
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China.,Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
| | - Guangming Zhang
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China.,Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
| | - Xiaoyong Han
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China.,Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
| | - Leisheng Zhang
- Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Hui Cai
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China.,General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, China.,Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors of Gansu Province, Lanzhou 730000, China
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19
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Wang J, Xue H, Chen Z, Wang Q, Yuan H, Zhang X. Safety of Early Oral Feeding After Laparoscopic Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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20
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Franceschilli M, Siragusa L, Usai V, Dhimolea S, Pirozzi B, Sibio S, Di Carlo S. Immunonutrition reduces complications rate and length of stay after laparoscopic total gastrectomy: a single unit retrospective study. Discov Oncol 2022; 13:62. [PMID: 35816241 PMCID: PMC9273797 DOI: 10.1007/s12672-022-00490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Preoperative immunonutrition (IN) reduces the incidence of postoperative complications in malnourished patients undergoing upper gastrointestinal surgery. However, its effect in norm-nourished patients remains unclear. Furthermore, patients with gastric cancer undergoing laparoscopic total gastrectomy (LTG) are not routinely included in protocols of enhanced recovery after surgery (ERAS). OBJECTIVE The aim of this study was to investigate the effects of perioperative IN in patients undergoing laparoscopic total gastrectomy (LTG) within an established ERAS pathway. METHODS A comparative retrospective study of patients undergoing LTG, receiving an immune-enhancing feed plus maltodextrin load the day of surgery (Group A) versus patients who had the same operation but no IN nor fast track management (group B). RESULTS There were no significant differences in patient demographic characteristics between the two groups but the medium age of patients in group A was older. Thirty-days postoperative complications were respectively 8.7% in Group A and 33.3% in Group B (p 0.04). Mean and median LOS for Group A and B were also significantly different: 7.2 ± 4.4 vs 10.3 ± 5.4 and 7 vs 10 days respectively. CONCLUSION Preoperative IN associated with ERAS protocol in normo-nourished patient undergoing LTG seems to reduce postoperative complications. Reduction in LOS is possibly associated to the ERAS protocol. Clinical trial registration Clinical trials.gov: NCT05259488.
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Affiliation(s)
- Marzia Franceschilli
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.
| | - Leandro Siragusa
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Valeria Usai
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Brunella Pirozzi
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Simone Sibio
- Department of Surgery "Pietro Valdoni", University "Sapienza" of Rome, Viale del Policlinico, Rome, Italy
| | - Sara Di Carlo
- Department of Surgery, University of Roma "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
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21
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Effect of Enhanced Recovery after Surgery with Integrated Traditional Chinese and Western Medicine on Postoperative Stress Response of Patients with Gastrointestinal Tumors. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3663246. [PMID: 35844438 PMCID: PMC9286946 DOI: 10.1155/2022/3663246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
Objective. To investigate the effect of enhanced recovery after surgery (ERAS) with integrated traditional Chinese and Western medicine on postoperative stress response of patients suffering from gastrointestinal tumors. Methods. A total of 74 patients with gastrointestinal tumors who underwent surgical treatment in our hospital from April 2019 to March 2021 were recruited and randomized into the control group and the observation group (1 : 1). The control group received routine treatment and care, while the observation group received ERAS plus integrated traditional Chinese and Western medicine. Clinical observation was performed regarding changes in preoperative mood and postoperative pain level in each group. Changes in expression levels of plasma cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-β (TNF-β) before and after surgery were detected in each group. Time of patients’ first fart and defecation and complications after surgery in each group were recorded. Results. The visual analogue scale (VAS) of patients in the observation group after 12 and 24 h of surgery was significantly lower than that in the control group (12 h: observation group 2.0 (1.00, 3.00) vs. control group 4.00 (3.00, 5.00),
; 24 h: observation group 2.00 (1.00, 3.00) vs. control group 3.00 (2.00, 5.00),
). The preoperative anxiety degree of patients in the two groups was not statistically significant (
). The plasma cortisol level of patients in the observation group after 24 and 48 h of surgery was significantly lower than that in the control group (24 h: observation group
nmol/L vs. control group
nmol/L,
; 48 h: observation group
nmol/L vs. control group
nmol/L,
). Patients’ postoperative CRP, IL-6, IL-8, and TNF-β expression levels in the observation group were remarkably lower than those in the control group at all time points. The first postoperative defecation came earlier in the observation group than that in the control group (observation group 76.00 h (64.50, 87.50) vs. control group 89.00 h (73.50, 116.00),
). There was 1 postoperative urinary tract infection in the observation group and 1 postoperative intestinal obstruction and 1 incisional wound infection in the control group. Conclusion. ERAS with integrated traditional Chinese and Western medicine could effectively reduce the postoperative stress response and inflammatory reaction in patients with gastrointestinal tumors, contributing to the safe and quick recovery of gastrointestinal functions of patients.
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22
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Yang M, Wu Y, Peng L, Kuang X. Analysis on Influencing Factors of Knowledge-Based Attitude and Behavior Change of Cardiovascular Disease Nurses. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8132478. [PMID: 35469228 PMCID: PMC9034923 DOI: 10.1155/2022/8132478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
Abstract
The study explores the influencing factors of knowledge, attitude, and behavior of cardiovascular disease nurses. A total of 500 CVD nurses from 10 hospitals in the province from January 2020 to 2021 are selected as the survey subjects. After reviewing the literature, a questionnaire is developed to investigate the knowledge, belief, and practice level of cardiovascular disease nurses. The demographic information, job information and knowledge, attitude, and behavior of cardiovascular disease nurses are investigated in the form of questionnaires. Univariate analysis is made on the knowledge, attitude, and behavior scores of the nurses with cardiovascular diseases in demographic characteristics and job characteristics, and multivariate stepwise analysis is made on the factors affecting the knowledge, attitude, and behavior of the nurses with cardiovascular diseases. Cardiovascular disease nurses' knowledge, attitude, and behavior are the medium level, should be regular training activities and psychological counseling, and cultivate high title, long working life, older nursing staff, and practice level.
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Affiliation(s)
- Manmei Yang
- Department of Cardiovascular Medicine, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
| | - Yongping Wu
- Outpatient Department, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
| | - Lihua Peng
- Department of Nursing, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
| | - Xuhuan Kuang
- Department of Nursing, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
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23
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Chen L, Cao LL, Chen SH. Effect of nursing model based on risk prediction with Logistic regression model on recovery of gastrointestinal motility function and quality of life in patients after gynecological laparoscopy. Shijie Huaren Xiaohua Zazhi 2022; 30:327-335. [DOI: 10.11569/wcjd.v30.i7.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic surgery is a common treatment in gynecology. Although it is a typical minimally invasive procedure, postoperative complications still exist and affect early postoperative recovery. Logistic regression models can be developed to obtain the weights of independent variables and to understand the risk factors for postoperative complications after laparoscopy, which can help to develop intervention strategies.
AIM To evaluate the effect of a nursing model based on the risk prediction with a Logistic regression model on the early postoperative recovery, gastrointestinal motility, and quality of life in patients after gynecological laparoscopy.
METHODS The case data of 232 patients undergoing gynecological laparoscopy at our hospital from January 2019 to January 2021 were selected to construct a Logistic regression model to predict the independent risk factors and incidence of gastrointestinal dysfunction after gynecological laparoscopy. Ninety-eight patients who would undergo gynecological laparoscopic surgery were prospectively selected and divided into either a control group or an observation group according to the order in which they were filed, with 49 cases in each group. The control group was given routine care, and the observation group adopted a care model based on the risk prediction using the Logistic regression model. The postoperative recovery status (time to first exhaust, time to first defecation, time to recovery of bowel sounds, and time to gastrointestinal peristalsis) and quality of life were compared between the two groups.
RESULTS Among 232 patients undergoing gynecological laparoscopy, the incidence of postoperative gastrointestinal dysfunction was 38.36%. Logistic regression analysis showed that age ≥ 60 years old, time to postoperative start of activity ≥ 3 d, drainage tube indwelling time ≥ 7 d, abnormal postoperative potassium, no use of postoperative analgesia, and no use of postoperative gastrointestinal motility drugs were independent risk factors for gastrointestinal dysfunction after gynecological laparoscopic surgery (P < 0.05). Based on these independent risk factors, a Logistic regression model was constructed, and the receiver operating characteristic curve (ROC) was drawn based on the predicted value and the true value. When Logistic (P) was > 0.209, the area under the curve was 0.859, the predictive sensitivity was 95.92%, and the specificity was 93.27%. The time to first exhaustion, time to first defecation, time to bowel sound recovery, and time to gastrointestinal peristalsis were shorter in the observation group than in the control group (P < 0.05). After intervention, the quality of life of patients in the observation group was significantly better than that of the control group (P < 0.05).
CONCLUSION The nursing model based on risk prediction using a Logistic regression model can promote the early recovery of patients undergoing gynecological laparoscopy, accelerate the recovery of gastrointestinal function, and improve their postoperative quality of life.
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Affiliation(s)
- Lin Chen
- Department of Obstetrics and Gynecology, People's Hospital of Pan'an County, Jinhua 322300, Zhejiang Province, China
| | - Li-Li Cao
- Department of Obstetrics and Gynecology, People's Hospital of Pan'an County, Jinhua 322300, Zhejiang Province, China
| | - Su-Hua Chen
- Department of Obstetrics and Gynecology, People's Hospital of Pan'an County, Jinhua 322300, Zhejiang Province, China
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24
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Zhou X, Zhou X, Cao J, Hu J, Topatana W, Li S, Juengpanich S, Lu Z, Zhang B, Feng X, Shen J, Chen M. Enhanced Recovery Care vs. Traditional Care in Laparoscopic Hepatectomy: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:850844. [PMID: 35392058 PMCID: PMC8980421 DOI: 10.3389/fsurg.2022.850844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Enhanced recovery care could alleviate surgical stress and accelerate the recovery rates of patients. Previous studies showed the benefits of enhanced recovery after surgery program in liver surgery, but the exact role in laparoscopic hepatectomy is still unclear. Aim We aimed to perform a meta-analysis to evaluate the safety and efficacy of enhanced recovery after a surgery program in laparoscopic hepatectomy. Methods The relative studies from a specific search of PUBMED, EMBASE, OVID, and Cochrane database from June 2008 to February 2022 were selected and included in this meta-analysis. The primary outcomes included length of hospital stay, duration to functional recovery, and overall postoperative complication rate. The secondary outcomes included operative time, intraoperative blood loss, cost of hospitalization, readmission rate, Grade I complication rate, and Grade II–V complication rate. Results A total of six studies with 643 patients [enhanced recovery care (n = 274) vs. traditional care (n = 369)] were eligible for analysis. These comprised three randomized controlled trials and three retrospective studies. Enhanced recovery care group was associated with decreased hospital stay [standard mean difference (SMD) = −0.56, 95% confidence interval (CI) = −0.83~−0.28, p < 0.0001], shorter duration to functional recovery (SMD = −1.14, 95% CI = −1.92~−0.37, p = 0.004), and lower cost of hospitalization Mean Difference (MD) = −1,539.62, 95% CI = −1992.85~−1086.39, p < 0.00001). Moreover, a lower overall postoperative complication rate was observed in enhanced recovery care group [Risk ratio (RR) = 0.64, 95% CI = 0.51~0.80, p < 0.0001] as well as lower Grade II–V complication rate (RR = 0.55, 95% CI = 0.38~0.80, p = 0.002), while there was no significant difference in intraoperative blood loss (MD = −65.75, 95% CI = −158.47~26.97, p = 0.16), operative time (MD = −5.44, 95% CI = −43.46~32.58, p = 0.78), intraoperative blood transfusion rate [Odds ratio (OR) = 0.71, 95% CI = 0.41~1.22, p = 0.22], and Grade I complication rate (RR = 0.73, 95% CI = 0.53~1.03, p = 0.07). Conclusion Enhanced recovery care in laparoscopic hepatectomy should be recommended, because it is not only safe and effective, but also can accelerate the postoperative recovery and lighten the financial burden of patients.
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Affiliation(s)
- Xueyin Zhou
- School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xueyi Zhou
- Department of Nursing, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Win Topatana
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Shijie Li
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Sarun Juengpanich
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziyi Lu
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xu Feng
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jiliang Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
- *Correspondence: Mingyu Chen
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25
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Zhou J, Lin S, Sun S, Zheng C, Wang J, He Q. Effect of single-incision laparoscopic distal gastrectomy guided by ERAS and the influence on immune function. World J Surg Oncol 2021; 19:307. [PMID: 34666774 PMCID: PMC8527799 DOI: 10.1186/s12957-021-02422-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background To evaluate the immune function of gastric cancer patients after single-incision laparoscopic distal gastrectomy (SIDG) or multiport laparoscopic distal gastrectomy (MLDG) guided by enhanced recovery after surgery (ERAS). Methods A retrospective cohort study was performed on 120 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The patients were divided into two groups according to operation method: group A (MLDG) and group B (SIDG), both guided by ERAS concept. The indicators reflecting immune function and inflammation, such as CD3+, CD4+, CD8+ and NK cell count, CD4+/CD8+ cell ratios, IgA, IgM and IgG levels, C-reactive protein (CRP), total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) were tested 3 days and 7 days after surgery. Results The skin incision length of patients in group B was significantly shorter than that in group A, but the operation time was significantly longer in group B than that in group A (P < 0.05). There were no significant differences in preoperative CD3+, CD4+, CD8+, natural killer (NK) cells, CD4+/CD8+, IgA, IgM and IgG levels between two groups (P < 0.05). Three days after surgery, the immune function indices were decreased in both groups, but with no significant difference between two groups (P > 0.05). On the 7th day after surgery, the immune indexes of both groups recovered somewhat, approaching the preoperative level (P > 0.05). Inflammation indexes increased 3 days after surgery and decreased 7 days after surgery in both groups, among them the CRP level in group A was higher than that in group B (P < 0.05). The 3-year survival rate were 96.7% in group A and 91.7% in group B, respectively, with no statistically significant difference. Conclusion Compared with MLDG guided by ERAS, SIDG under the guidance of the ERAS concept has better cosmetic effect and similar effect on immune function of gastric cancer patients.
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Affiliation(s)
- Junfeng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Sheng Lin
- Department of Pediatric Surgery, Fujian Children's Hospital, Fujian, 350005, Fuzhou, PR China
| | - Sida Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Chengying Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Jiaxing Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Qingliang He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China.
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26
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Jia H, Wang S, Shen L, You J, Yang F, Abe M, Xu Y, Zong L. Ultrasound delivery of Chinese rhubarb promotes early recovery of gastrointestinal function after gastrectomy: a prospective randomized controlled study. JOURNAL OF BIO-X RESEARCH 2021; 04:130-135. [DOI: 10.1097/jbr.0000000000000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective:
Chinese rhubarb is a promising Chinese medicine for the promotion of gastrointestinal function. This study was conducted to investigate the safety and efficacy of Chinese rhubarb administered via ultrasound delivery in promoting the early recovery of gastrointestinal function after gastrectomy.
Methods:
In this prospective randomized controlled study, 100 patients who were scheduled to undergo total or subtotal gastrectomy in Changzhi People’s Hospital or Subei People’s Hospital from August 2017 to January 2018 were recruited. These patients were randomly assigned into two equal groups before surgery: 50 in the experimental (Chinese rhubarb) group, and 50 in the control (routine nursing) group. After surgery, time to flatus, bowel movement, clear liquid diet, and removal of nasogastric tube were recorded and analyzed. In addition, postoperative pain, postoperative bowel movement-related complications, and postoperative hospital stay duration were also recorded and analyzed. The study was approved by The protocol was approved by the Institutional Review Board of Changzhi People’s Hospital and Subei People’s Hospital on July 1, 2017 and registered with the Chinese Clinical Trial Registry on December 17, 2018 (registration number: ChiCTR1800020143).
Results:
Time to flatus (control group 85.68±22.00 hours vs experimental group 73.06±23.42 hours;
P
=0.007), bowel movement (5.52±1.56 vs 4.40±1.21 days;
P
<0.001), clear liquid diet (6.72±1.16 vs 6.22±1.28 days;
P
=0.044), and removal of nasogastric tube (6.30±1.52 vs 5.65±1.58 days;
P
=0.044) were significantly shorter in the experimental group compared with the control group, as was the postoperative hospital stay duration (14.30±3.46 vs 12.86±1.36 days;
P
=0.006). In addition, better pain relief (
P
=0.003) and a lower incidence of postoperative bowel movement-related complications (6 vs 21;
P
=0.001) were noted in the experimental group.
Conclusion:
Ultrasound delivery of Chinese rhubarb is useful to promote the early recovery of gastrointestinal function after gastrectomy.
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Affiliation(s)
- Hengbo Jia
- Department of Nursing, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
- Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Shaofeng Wang
- Department of Gastroenterology, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Lujun Shen
- Department of Gastroenterology, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Jun You
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China
| | - Fan Yang
- Department of Central Laboratory, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Masanobu Abe
- Division for Health Service Promotion, University of Tokyo Hospital, Tokyo, Japan
| | - Yingying Xu
- Department of Gastrointestinal Surgery, Yizheng People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Liang Zong
- Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
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