[Observation of fast track surgery in patients with gastric cancer].

OBJECTIVE: To investigate the effects of fast track surgery on patients with gastric cancer in perioperative period. METHODS: Ninety-two patients with gastric cancer undergone radical operations were randomly divided into two groups: fast track group (n=46, fast track surgery) and control group(n=46, traditional surgery). Serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C reaction protein (CRP) in the 92 patients were assayed preoperatively and at day 1, 3, 7 postoperatively, and the resting energy expenditure (REE) was also measured by indirect calorimetry in the morning. The postoperative hospital stay, duration of fever, medical cost, postoperative time of flatus and postoperative complications were recorded and compared respectively. RESULTS: At postoperative day 1 and 3, serum levels of TNF-alpha were (12.67+/-2.68) fmmol/L and (13.19+/-2.75) fmmol/L in fast track group, (14.74+/-3.18) fmmol/L and (15.56+/-2.99) fmmol/L in control group; serum levels of IL-6 were (112.52+/-24.73) ng/L and (129.03+/-22.75) ng/L in fast track group, (123.90+/-22.52) ng/L and (142.67+/-20.33) ng/L in control group. The levels of IL-6 and TNF-alpha in fast track group were significantly lower than those in control group (all P<0.05). At postoperative day 1, 3 and 7, serum levels of CRP in fast track group were significantly lower than those in control group [d1(56.20+/-11.47) g/L vs (71.07+/-17.32) g/L, d3(136.09+/-19.78) g/L vs (157.78+/-28.18) g/L, d7 (48.53+/-12.95) g/L vs (64.72+/-19.73) g/L] (all P<0.05). At postoperative day 1 and day 3, the REE in fast track group were significantly lower those than in control group [d1(5713.96+/-619.44) kJ/d vs (6176.04+/-614.46) kJ/d, d3 (5298.49+/-639.36) kJ/d vs (5627.94+/-656.72) kJ/d] (all P<0.05). The postoperative duration of fever [2(2.0-3.0) d vs 4(2.8-4.0) d], postoperative time of flatus [3(2.0-4.0) d vs 4(3.8-5.0) d], postoperative hospital stay [6(6.0-7.0) d vs 8(7.0-8.3) d] and treatment expense [(27 201+/-3857) Chinese yuan vs (31 006+/-3555) Chinese yuan] in fast track group were also significantly lower than those in control group (P<0.01). There were no significant differences in complications between the two groups(P>0.05). The quality of life score on discharge in fast track group was significantly higher than that in control group (15.74+/-1.82 vs 14.67+/-1.27, P<0.01). CONCLUSION: Fast track surgery can ameliorate stress reaction, decrease postoperative patients' REE during perioperative period and accelerate the rehabilitation of patients with gastric cancer.