Abstract: Objective:To investigate the value of fast track surgery (FTS) principles in the perioperative management of liver cancer patients after hepatectomy.
Methods:Forty patients with primary liver cancer who were admitted to the First People′s Hospital of Qinzhou from September 2011 to July 2013 were enrolled in this prospective study. All the patients were randomly divided into the FTS group (20 patients) and the control group (20 patients) according to the random number table. The perioperative management of patients in the FTS group was guided by the FTS principles, patients in the control group were managed with traditional methods. The intra operative condition, time for portal occlusion, operation time, volume of intraoperative blood loss and blood transfusion, time to drainage tube removal, time to flatus and defecation, duration of postoperative hospital stay, expenses, changes of C reactive protein on postoperative day 1, 3, 6, recovery of hepatic function and incidence of post operative complications. All patients were followed up via phone call and out patient examination till September 2013. All data were analyzed using the t test or chi square test. The non normal distribution paramenters were analyzed using the rank sum test.
Results:All patients were cured with no perioperative death. The time for postoperative drainage tube removal, time to flatus and defecation, duration of postoperative hospital stay and expenses were (2.3±1.0)days, (2.5±0.5)days, (3.1±0.7)days, (7.0±0.8)days and (3.6±0.3)×10 4 yuan in the FTS group, and (4.6±0.7)days, (4.3±0.7)days, (4.8±0.4)days, (8.5±0.9)days and (4.1±0.3)×10 4 yuan, with significant differences between the 2 groups (t=0.74, 0.34, 1.70, 0.23, 0.57, P<0.05). The levels of C reactive proteins at postoperative day 1, 3, 6 were (56±7)mg/L, (122±7)mg/L and (35±7)mg/L in the FTS group, and (198±24)mg/L, (137±5)mg/L and (49±8)mg/L, with significant differences between the 2 groups (F=64.91, P<0.05). The levels of prealbumin at postoperative day 1, 3, 6 were (196±14)mg/L, (243±17)mg/L, (260±10)mg/L in the FTS group, and (198±24)mg/L, (199±16)mg/L and (245±7)mg/L in the control group, with significant differences between the 2 groups (F=22.69, P<0.05). The levels of alanine transaminase at postoperative day 1, 3, 6 were (379±34)U/L, (166±12)U/L, (49±14)U/L in the FTS group, and (367±75)U/L, (210±28)U/L, (197±22)U/L in the control group, with significant differences between the 2 groups (F=4.51, P<0.05). One patient was complicated with peritoneal effusion and 1 with thoracic effusion in the FTS group; 4 patients was complicated with peritoneal effusion, 3 with thoracic effusion, 4 with pulmonary infection and 2 with incisional infection in the control group, with no significant difference in the complication between the 2 groups (χ ²=0.78, 1.11, 4.44, 2.11, P>0.05). All the patients were followed up for 2 -24 months, no patients received reoperation or re admitted to the hospital due to complications.
Conclusion:The application of FTS principle in the perioperative management of liver cancer patients after hepatectomy is safe and effective, it could alleviate the post operative stress reaction and accelerate the recovery of liver function and patients′ condition.