The investigators designed a prospective randomized, controlled clinical trial then recruited 149 consecutive advanced gastric cancer patients. Further divided into a ERAS group (n=73) and a conventional pathway group (n=76). Surgical technique in both groups was same laparoscopic-assisted gastrectomy with D2 lymphadenectomy. Compared outcomes included clinical parameters and serum indicators.
Enhanced recovery after surgery combined with laparoscopic-assisted gastrectomy was successfully carried out in this study. Recovery parameters such as the length of time to return to normal diet,mean hospital stay (d) were recorded.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
149
Normal meal allowed until 6 h before surgery and Carbohydrate drink until 2 h before surgery
No bowel preparation
No nasogastric placement; if used, remove on the 1st postoperative day
Compartition of postoperative hospital stay
Time frame: up to 30 days after the operation
Change from baseline in C-Reactive Protein( CRP) and visceral proteins level
1day before and 1-5days after operation
Time frame: baseline and 5 days
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Vasoactive drugs used if need be
Temperature management
Intra-abdominal drains not to be used
Intraperitoneal Ropivicaine infusion
On the 1st postoperative day Nasogastric catheter removed /Urinary catheter removed. Oral non-opioid analgesia/Drinking 0.5L liquid. Active mobilisation
On the 2nd postoperative day：Drains removed Oral diet was initiated
3-4th postoperative day： Stop oral non opioid analgesia
On the5-6th postoperative day Check discharge criteria
No solid foods at dinner before surgery and no liquids 12 h before surgery. Routine bowel preparation Nasogastric placement on the morning of surgery
Routine use of anesthesia medicine. Standard 5-trocar laparoscopy-assisted procedure. I.V. fluids not restricted (Ringer's lactate 20 ml/kg in the first hour, then at the rate of 10-12 ml/kg/h) Routine use of abdominal drainage tubes and placement of catheters.
1st postoperative day: Keep Nasogastric catheter Removal of urinary catheter Opioid analgesic by intramuscular injection Parenteral nutrition until flatus. I.V. fluids not restricted Mobilization in bed
2nd postoperative day Patient is advised to get out of bed until 24-48h after surgery
3-4th postoperative day： Remove nasogastric tube after flatus Oral liquids started. Encouraged to walk in the ward.
5-6th postoperative day：Oral diet was changed from liquids to semi-fluids and normal food. Drains removed