Clinical efficacy of single-port plus one-port laparoscopic radical gastrectomy: a short-term analysis

• Main Authors: JIANG Enlai, WANG Shuai, DU Guangsheng, Guangsheng, QIU Yuan, LI Yunbo
• Format: Article
• Language: zho
• Published: Editorial Office of Journal of Third Military Medical University 2019-12-01
• Series: Di-san junyi daxue xuebao
• Subjects: enhanced recovery after surgery; gastric cancer; sils +1 laparoscopic surgery; stress indicators
• Online Access: http://aammt.tmmu.edu.cn/Upload/rhtml/2019009006.htm

Objective To compare the short-term efficacy and stress indexes in patients after radical gastric cancer surgery between single-port plus one-port (SILS+1) laparoscope and traditional five-port laparoscope based on enhanced recovery after surgery (ERAS). Methods A total of 114 patients who underwent laparoscopic radical gastrectomy in our department from March 2017 to July 2019 were recruited in this ERAS study. According the surgical approach, they were divided into SILS+1 group (n=66) and traditional laparoscopic group (n=48). The levels of white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and interleukin-6 (IL-6) at 1, 3 and 5 d after surgery were recorded and compared between the 2 groups. What's more, operation time, incision length, intraoperative blood loss, tumor type and TNM stage were compared between the 2 groups, and the time of gastric tube removal, time of first feeding, time of first movement out of bed, time of first anal exhaust, time of first defecation and time of postoperative hospitalization were recorded. Results ① There were no statistically significant differences in age, sex, BMI and tumor stage, or in WBC, CRP, ESR, PCT and IL-6 levels in 1 d before surgery between the 2 groups (P>0.05). ② The SILS+1 laparoscopic group had significantly longer operation time than the traditional laparoscopic group (P < 0.05). ③ The WBC, CRP, ESR, PCT and IL-6 levels at 1, 3 and 5 d after surgery were significantly lower in the SILS+1 laparoscopic group than the traditional group (P < 0.05). ④ The incision length, first anal exhaust time, first postoperative defecation time and total hospital stay were significantly shorter in the laparoscopic SILS+1 group than the traditional group (P < 0.05). There were no statistical differences in the time of gastric tube removal, time of first feeding and time of first getting out of bed between them (P>0.05). Conclusion Under the concept of ERAS, although SILS+1 laparoscope prolongs the operation time when compared with the traditional five-port laparoscope, it can obtain better short-term clinical efficacy, and is helpful to reduce the stress responses and promote the early recovery in the patients after radical gastric cancer surgery.