Effect of enhanced recovery after surgery on early prognosis of patients undergoing pancreatoduodenectomy with precancerous approach of pancreatic head

doi:10.3877/cma.j.issn.1674-3946.2022.04.010

Abstract

Abstract:

Objective

To analyze the effect of enhanced recovery after surgery（ERAS）on the early prognosis of patients undergoing pancreatoduodenectomy with precancerous approach of pancreatic head.

Methods

98 patients with pancreatic head cancer treated from July 2018 to July 2020 were randomly divided into ERAS group and routine group，with 49 cases in each group undergoing anterior approach orthotopic pancreaticoduodenectomy. Routine group received routine rehabilitation intervention during perioperative period，while ERAS group received perioperative intervention based on ERAS concept. SPSS 22.0 statistical software was used to analyze the data. Intraoperative and postoperative measurement data were expressed as（

x ˉ

±s）. Independent sample t test was performed；The incidence of postoperative complications，the rate of second operation and the results of 1-year follow-up were tested by χ² test. P<0.05 was considered statistically significant.

Results

The postoperative hospital stay，anal exhaust time and drainage tube removal time of the fast rehabilitation group were lower than those of the conventional group（P<0.05）. The incidence of postoperative complications in the ERAS gruop was 14.3%，which was lower than 42.9% in the conventional group（P<0.05）. The second operation rate of fast rehabilitation group was 22.4%，which was lower than 42.9% of conventional group（P<0.05）. One year after operation，there was no significant difference in local recurrence rate，distant metastasis rate and mortality rate between ERAS gruop and conventional group（P>0.05）.

Conclusion

ERAS can promote early recovery after pancreatoduodenectomy via anterior approach，and reduce the incidence of complications and reoperation rate.

Key words: Pancreatic head cancer, Enhanced recovery after surgery, Pancreatoduodenectomy, Prognosis

Mingyao Wu, Shiran Gong, Tingting Bao, Jie Tan. Effect of enhanced recovery after surgery on early prognosis of patients undergoing pancreatoduodenectomy with precancerous approach of pancreatic head[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(04): 382-385.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2022.04.010

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2022/V16/I04/382

Figures/Tables 5

References 19

[1]	Sandrucci S，Beets G，Braga M，et al. Perioperative nutrition and enhanced recovery after surgery in gastrointestinal cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society（ERAS coalition）［J］. Eur J Surg Oncol，2018，44（4）：509-514.
[2]	徐家明，汤东，王道荣，等. 加速康复外科理念下经自然腔道取标本手术治疗结直肠癌围手术期疗效［J/CD］. 中华普外科手术学杂志（电子版），2019，13（1）：29-32.
[3]	耿炜，彭金茹，赵雪琪，等. 加速康复外科模式对腹腔镜下胰十二指肠切除术后患者肠道黏膜屏障影响的研究［J/CD］. 中华普外科手术学杂志（电子版），2020，14（3）：260-263.
[4]	Liu Y，Qin P，Wu R，et al. ERas regulates cell proliferation and epithelial–mesenchymal transition by affecting Erk/Akt signaling pathway in pancreatic cancer［J］. Hum Cell，2020，33（4）：1186-1196.
[5]	朱序勤，贾淞淋，祁洁，等. 影响胰腺癌根治术预后的围手术期相关因素的回顾性分析［J］. 中国癌症杂志，2019，29（7）：521-527.
[6]	Pędziwiatr M，Mavrikis J，Witowski J，et al. Current status of enhanced recovery after surgery（ERAS）protocol in gastrointestinal surgery［J］. Med Oncol，2018，35（6）：95.
[7]	王瑞芳，李春玲，李敏，等. 加速康复外科理念的临床护理路径在腹腔镜胰体尾切除术围手术期的应用［J］. 腹腔镜外科杂志，2019，24（3）：239-240.
[8]	Melloul E，Lassen K，Roulin D，et al. Guidelines for perioperative care for pancreatoduodenectomy：enhanced recovery after surgery（ERAS）recommendations 2019［J］. World J Surg，2020，44（7）：2056-2084.
[9]	Ljungqvist O，Young-Fadok T，Demartines N. The history of enhanced recovery after surgery and the ERAS society［J］. J Laparoendoscopic Adv Surgical Tech A，2017，27（9）：860-862.
[10]	St-Amour P，St-Amour P，Joliat GR，et al. Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic malignancies［J］. Langenbecks Arch Surg，2020，405（7）：959-966.
[11]	王晶，吴安石，艾攀，等. 超声引导下腹横平面阻滞与切口局部浸润对腹腔镜膀胱癌根治术患者快速恢复的影响［J］. 基础医学与临床，2019，39（6）：826-831.
[12]	傅德良，蒋永剑. 老年胰腺术后快速康复研究进展［J］. 实用老年医学，2017，31（12）：1103-1106.
[13]	van Dijk DPJ，van Woerden V，Cakir H，et al. ERAS：improving outcome in the cachectic HPB patient［J］. J Surgi Oncol，2017，116（5）：617-622.
[14]	Agarwal V，Thomas MJ，Joshi R，et al. Improved outcomes in 394 pancreatic cancer resections：The impact of enhanced recovery pathway［J］. J Gastrointest Surg，2018，22（10）：1732-1742.
[15]	冯梦宇，张太平，赵玉沛. 加速康复外科在胰腺外科中的应用［J］. 浙江大学学报（医学版），2017，46（6）：666-674.
[16]	Deng X，Cheng X，Huo Z，et al. Modified protocol for enhanced recovery after surgery is beneficial for Chinese cancer patients undergoing pancreaticoduodenectomy［J］. Oncotarget，2017，8（29）：47841-47848.
[17]	Kowalsky SJ，Zenati MS，Steve J，et al. A combination of robotic approach and ERAS pathway optimizes outcomes and cost for pancreatoduodenectomy［J］. Ann Surg，2019，269（6）：1138-1145.
[18]	Passeri M，Lyman WB，Murphy K，et al. Implementing an ERAS protocol for pancreaticoduodenectomy does not affect oncologic outcomes when compared with traditional recovery［J］. Am Surg，2020，86（2）：e81-e83.
[19]	郭强，钟锴，蒋铁民，等. 加速康复外科理念在胰十二指肠切除术围手术期中的疗效分析［J/CD］. 中华普外科手术学杂志（电子版），2020，14（3）：252-255.

组别	例	年龄 (岁)	肿瘤直径 (cm)	性别	分化程度
组别	例	年龄 (岁)	肿瘤直径 (cm)	男/女	低/中高
ERAS组	49	54.1±7.5	4.0±0.7	27/22	14/35
常规组	49	54.5±7.4	4.0±0.7	25/24	17/32
t/χ²		0.312	0.488	0.164	0.425
P		0.756	0.627	0.686	0.515

组别	例	年龄 (岁)	肿瘤直径 (cm)	性别	分化程度
组别	例	年龄 (岁)	肿瘤直径 (cm)	男/女	低/中高
ERAS组	49	54.1±7.5	4.0±0.7	27/22	14/35
常规组	49	54.5±7.4	4.0±0.7	25/24	17/32
t/χ²		0.312	0.488	0.164	0.425
P		0.756	0.627	0.686	0.515

组别	例	术后住院时间	肛门排气时间	引流管拔除时间
ERAS组	49	10.4±1.7	2.8±0.4	5.3±0.9
常规组	49	14.3±2.1	5.3±1.2	7.3±1.6
t		10.183	13.509	7.679
P		0.000	0.000	0.000

组别	例	术后住院时间	肛门排气时间	引流管拔除时间
ERAS组	49	10.4±1.7	2.8±0.4	5.3±0.9
常规组	49	14.3±2.1	5.3±1.2	7.3±1.6
t		10.183	13.509	7.679
P		0.000	0.000	0.000

组别	例	腹腔出血	腹腔积液	胆胰引流口瘘	其他	合计
ERAS组	49	1(2.0)	2(4.1)	1(2.0)	3(6.1)	7(14.3)
常规组	49	6(12.2)	7(14.3)	3(6.1)	5(10.2)	21(42.9)
χ²		2.462	1.958	0.261	0.136	9.800
P		0.117	0.162	0.610	0.712	0.002

Please choose a citation manager

Content to export