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Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial

 Jong Won Kim  ;  Whan Sik Kim  ;  Jae-Ho Cheong  ;  Woo Jin Hyung  ;  Seung-Ho Choi  ;  Sung Hoon Noh 
 WORLD JOURNAL OF SURGERY, Vol.36(12) : 2879-2887, 2012 
Journal Title
Issue Date
Adenocarcinoma/surgery* ; Adult ; Aged ; Anesthetics, Local/therapeutic use ; Bupivacaine/therapeutic use ; Early Ambulation ; Female ; Follow-Up Studies ; Gastrectomy/methods ; Gastrectomy/rehabilitation* ; Gastroenterostomy ; Humans ; Laparoscopy* ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Pain, Postoperative/drug therapy ; Perioperative Care/methods* ; Prospective Studies ; Recovery of Function ; Stomach Neoplasms/surgery* ; Treatment Outcome
Gastric Cancer ; Anastomotic Stricture ; Conventional Group ; Laparoscopic Distal Gastrectomy ; Ketorolac Tromethamine
BACKGROUND: Fast-track surgery has been shown to enhance postoperative recovery in several surgical fields. This study aimed to evaluate the safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy. METHODS: The present study was designed as a single-center, randomized, unblinded, parallel-group trial. Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated. The fast-track surgery protocol included intensive preoperative education, a short duration of fasting, a preoperative carbohydrate load, early postoperative ambulation, early feeding, and sufficient pain control using local anesthetics perfused via a local anesthesia pump device, with limited use of opioids. The primary endpoint was the duration of possible and actual postoperative hospital stay. RESULTS: We randomized 47 patients into a fast-track group (n=22) and a conventional pathway group (n=22), with three patients withdrawn. The possible and actual postoperative hospital stays were shorter in the fast-track group than in the conventional group (4.68±0.65 vs. 7.05±0.65; P<0.001 and 5.36±1.46 vs. 7.95±1.98; P<0.001). The time to first flatus and pain intensity were not different between groups; however, a greater frequency of additional pain control was needed in the conventional group (3.64±3.66 vs. 1.64±1.33; P=0.023). The fast-track group was superior to the conventional group in several factors of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, including: fatigue, appetite loss, financial problems, and anxiety. The complication and readmission rates were similar between groups. CONCLUSIONS: Fast-track surgery could enhance postoperative recovery, improve immediate postoperative quality of life, and be safely applied in laparoscopic distal gastrectomy
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Whan Sik(김완식)
Kim, Jong Won(김종원)
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Cheong, Jae Ho(정재호) ORCID logo https://orcid.org/0000-0002-1703-1781
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0002-9872-3594
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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