Enhanced recovery after surgery in total laparoscopic radical gastrectomy

Objective To investigate the effect of enhanced recovery after surgery(ERAS) on immune function and postoperative recovery in gastric cancer patients undergoing total laparoscopic radical gastrectomy. Methods Patients were randomly divided into ERAS group and control group. Blood CD4+ , CD8+ , CD4+ CD25+ , C-reactive protein , postoperative recovery and complications were compared between the two groups. Results On day1, CD4+ , CD8+ , CD4+ CD25+ in the two groups were significantly lower than those before surgery (t=9.070, 7.297, 5.830, 12.870, 3.529, 10.547, all P 0.05) while the other indexes in the two groups raised but still were lower than preoperative level (t=3.322, 5.015, 3.418, 9.912, all P<0.05); CD4+ , CD8+ , CD4+ CD25+ in ERAS group were higher than control group (t=2.804, 2.040, 2.210, allP<0.05). On day5, CD4+ , CD4+ CD25+ in the two groups and CD8+ in ERAS group returned to the preoperative level, while CD8+ of the control group was still lower than the preoperative level (t=6.862, P<0.05). On day1, 3 and 5, the C-reactive protein levels of the two groups were higher than those before surgery(t=-13.338, -13.715, -11.319, -12.286, -13.182, -15.076, all P<0.05), and ERAS group were lower than the control group (t=-3.246, -2.100, -2.211, all P<0.05). There was no mortality in neither groups. The time of passage gas by anus, defecation, getting out of bed, oral feeding, and postoperative hospital stay in the ERAS group were less than those in the control group[(2.8±1.0)d vs. (3.9±0.9)d, t=-5.974; (3.8± 0.9)d vs.(4.3±1.0)d, t=-2.700; (19.1±4.0)h vs. (35.9±6.6)h, t=-16.045; (9.9±1.6)d vs. (11.5±2.0)d, t=-4.479, all P<0.05]. Conclusions ERAS in the perioperative period of patients with total laparoscopic radical gastrectomy mitigates the stress on the cellular immune system, reduces inflammatory response, and help fast recover the postoperative gastrointestinal function.