PMID- 32927324
OWN - NLM
STAT- MEDLINE
DCOM- 20210104
LR  - 20210104
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 257
DP  - 2021 Jan
TI  - Enhanced Recovery after Surgery in Elderly Gastric Cancer Patients Undergoing 
      Laparoscopic Total Gastrectomy.
PG  - 579-586
LID - S0022-4804(20)30494-7 [pii]
LID - 10.1016/j.jss.2020.07.037 [doi]
AB  - BACKGROUND: The aim of this study was to evaluate the effects of the enhanced 
      recovery after surgery (ERAS) program versus conventional perioperative care on 
      the short-term postoperative outcomes among elderly patients with gastric cancer 
      who are undergoing laparoscopic total gastrectomy. METHODS: Elderly patients with 
      gastric cancer (age >/= 65 y) who are undergoing laparoscopic total gastrectomy 
      were randomized to ERAS or conventional perioperative care groups. Short-term 
      postoperative outcomes, including postoperative hospital stay, mortality, 
      complications, readmission rate, and reoperation rate were compared between the 
      two groups. In addition, blood samples were taken preoperatively (baseline) and 
      on postoperative days 1, 3, and 5. Systemic human leukocyte antigen (HLA)-DR 
      expression on monocytes and C-reactive protein (CRP) were analyzed. RESULTS: Of 
      the 171 eligible patients, 85 patients were assigned to receive ERAS program 
      treatment (ERAS group) and 86 patients to receive conventional care (conventional 
      group). The patients' characteristics were comparable. Postoperative hospital 
      stay was shorter in the ERAS group than in the conventional group (11 [7-11] 
      versus 13 [8-20] d, P < 0.001). Hospital mortality, overall morbidity, 
      morbidity >/= Clavien-Dindo (C-D) grade II, readmission rate, and reoperation rate 
      did not show significant differences between the two groups. However, 
      morbidity >/= C-D grade IIIa was lower in the ERAS group than that in the 
      conventional group (8.2% versus 18.6%, P = 0.047). The ERAS program shortened the 
      number of days to postoperative first flatus, first defecation, semifluid diet, 
      and soft bland diet. Moreover, the ERAS program increased the HLA-DR expression 
      on monocytes and decreased the CRP levels on postoperative days 1, 3, and 5. 
      CONCLUSIONS: The ERAS program was feasible and effective for elderly patients 
      with gastric cancer who are undergoing laparoscopic total gastrectomy. The 
      benefits of ERAS were associated with improvement of impaired immune function and 
      suppression of inflammatory reaction.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Cao, Shougen
AU  - Cao S
AD  - Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao 
      University, Shandong, China.
FAU - Zheng, Taohua
AU  - Zheng T
AD  - Liver Disease Center, Affiliated Hospital of Qingdao University, Shandong, China.
FAU - Wang, Hao
AU  - Wang H
AD  - Department of General Surgery, Dongying People's Hospital, Shandong, China.
FAU - Niu, Zhaojian
AU  - Niu Z
AD  - Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao 
      University, Shandong, China.
FAU - Chen, Dong
AU  - Chen D
AD  - Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao 
      University, Shandong, China.
FAU - Zhang, Jian
AU  - Zhang J
AD  - Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao 
      University, Shandong, China.
FAU - Lv, Liang
AU  - Lv L
AD  - Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao 
      University, Shandong, China.
FAU - Zhou, Yanbing
AU  - Zhou Y
AD  - Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao 
      University, Shandong, China. Electronic address: yanbingzhou999@hotmail.com.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20200911
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
RN  - 0 (HLA-DR Antigens)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Aged
MH  - C-Reactive Protein/metabolism
MH  - *Enhanced Recovery After Surgery
MH  - Female
MH  - *Gastrectomy
MH  - HLA-DR Antigens/metabolism
MH  - Humans
MH  - Laparoscopy
MH  - Male
MH  - Prospective Studies
MH  - Stomach Neoplasms/*surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Elderly patients
OT  - Enhanced recovery after surgery
OT  - Gastric cancer
OT  - Laparoscopic total gastrectomy
EDAT- 2020/09/15 06:00
MHDA- 2021/01/05 06:00
CRDT- 2020/09/14 20:19
PHST- 2019/04/30 00:00 [received]
PHST- 2020/05/08 00:00 [revised]
PHST- 2020/07/11 00:00 [accepted]
PHST- 2020/09/15 06:00 [pubmed]
PHST- 2021/01/05 06:00 [medline]
PHST- 2020/09/14 20:19 [entrez]
AID - S0022-4804(20)30494-7 [pii]
AID - 10.1016/j.jss.2020.07.037 [doi]
PST - ppublish
SO  - J Surg Res. 2021 Jan;257:579-586. doi: 10.1016/j.jss.2020.07.037. Epub 2020 Sep 
      11.