A phase II study of an enhanced recovery after surgery protocol in gastric cancer surgery

Abstract

Background The enhanced recovery after surgery (ERAS) protocol integrates a number of perioperative interventions and techniques, aiming at decreasing the morbidity rate and the length of postoperative hospital stay after surgery. Although it has become a standard perioperative management for colorectal surgery, the feasibility of the ERAS protocol for gastric surgery remains unclear. Methods This single-center, prospective phase II study included patients with gastric cancer undergoing curative gastrectomy. The primary end point was the incidence of Clavien-Dindo grade II or higher postoperative complications. The secondary end points were the incidence of anastomotic leakage, the incidence of pneumonia, the proportion of patients starting oral feeding at postoperative day 2, the completion rate of the ERAS protocol, the length of postoperative hospital stay, the readmission rate within 30 days after discharge, and the mortality rate. Results From September 2013 to September 2014, 121 eligible patients were enrolled in this study. The incidence of postoperative complications was 10.7 % (90 % confidence interval, 6.47-16.54 %). Anastomotic leakage and pneumonia was observed in one and zero patients, respectively. The median length of postoperative hospital stay was 8 days, and the completion rate of the ERAS protocol was 85.1 %. The readmission rate and the mortality rate were 0 %. Conclusions The ERAS protocol can be safely used in patients undergoing gastric cancer surgery. The superiority of the ERAS protocol over non-ERAS perioperative management should be clarified.

Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial

“…Although some reports have described the use of the ERAS protocol for patients undergoing surgery for gastric cancer, clear and convincing evidence for the usefulness of this protocol for such patients has not been established [15][16][17][18][19][20][21][22]. Consensus guidelines for enhanced recovery after gastrectomy have been published [23].…”

Unplanned admission after gastrectomy as a consequence of fast-track surgery: a comparative risk analysis

“…Perioperative management reflecting concepts such as fast-track surgery and enhanced recovery after surgery has recently been used for gastric cancer surgery [1][2][3], These interventions are expected to enhance recovery of intestinal mobility, prevent the incidence of postoperative complications such as respiratory disease and thrombosis, and contribute to reducing the length of postoperative hospitalization and medical costs [2,[4][5][6], ultimately leading to patient satisfaction. On the other hand, there is concern about the association between impetuous use of such management and patient risk.…”

Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

“…In a systematic review and meta-analysis of nine trials (two were randomized controlled), Hughes et al reported that ERAS protocols were associated with decreased morbidity and LOS after hepatic resection [14]. Similar results have been reported in cases of bladder, esophagus, gastric, bariatric, gynecologic, and emergent surgeries that have implemented the ERAS protocols [15–25]. …”