Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

Abstract

Background We aimed to evaluate the safety and efficacy of a clinical pathway (CP) for enhanced recovery after surgery (ERAS) in gastric cancer patients, including early oral feeding and discharge on postoperative day 4. Methods We performed a prospective, single‐center, phase II clinical trial. Based on proposed indications for an ERAS CP in our retrospective study, we enrolled 133 patients younger than 65 years who were undergoing minimally invasive subtotal gastrectomy. The primary endpoint was the ERAS CP completion rate. Secondary endpoints included complication, mortality, hospital stay, and readmission. Results Among 133 patients, six patients were dropped out from this study. The ERAS CP completion rate (77.2%, 98 of 127) was comparable to the historical control group that completed a conventional CP (85.4%, P = .085). The postoperative complication incidence (13.4%, 15 of 127) was also similar to that of the conventional CP group (9.5%, P = .174). We identified reduced hospital stays (4.7 ± 1.3 vs 7.2±2.3 days; P < .001) and lower hospital costs ($7771 vs 8539; P < .001) in the ERAS CP group compared with the conventional CP group. Conclusions An ERAS CP can be safely and effectively adopted for patients with gastric cancer without increasing the complication rate and could shorten hospital stays. Trial Registration http://ClinicalTrials.gov (NCT01642953).

Clinical Pathways for Oncological Gastrectomy: Are They a Suitable Instrument for Process Standardization to Improve Process and Outcome Quality for Patients Undergoing Gastrectomy? A Retrospective Cohort Study

“…In summary, the implementation of a CP for oncological gastrectomy at our institution did not lead entirely to the results that were expected based on studies on gastrectomy CPs in Asian settings [32,33], and on studies on CPs for other procedures in abdominal surgery at our institution and in other settings [13,[34][35][36][37][38][39][40]. The reasons for this apparent difference in the efficacy of gastrectomy and other abdominal surgery CPs can only be speculated on.…”

Faster recovery and bowel movement after early oral feeding compared to late oral feeding after upper GI tumor resections: a meta-analysis

“…In this study, the hospital length of stay in the early feeding group was significantly lower than that in the LOF group. However, the complication rate was not found to be higher in the EOF group ( 38 ).…”

Did the ERAS Protocol Improve Our Results in Locally Advanced Gastric Cancer Surgery?

“…According to ERAS protocol, early oral intake can be initiated without any complications. Jeonget al reported that most patients could resume an oral diet within 1 or 2 days with conservative care, and no serious complication occurred that was associated with early oral nutrition, such as aspiration or anastomosis leakage [ 13 ].Jie Ding et al reported that in meta-analysis studies, a reduction in time to first flatus is an important part of ERAS [ 16 ].Rohck et al achieved their goal of early oral feeding and discharge on the 4th day after surgery in 127 patients with stage 1 and 2a gastric cancer, with a rate of 77% [ 17 ]. Li et al determined that ERAS did not prolong the time to first flatus and did not increase complication rate in their eight RCT and meta-analysis series consisting of 400 cases [ 18 ].Liayang et al reported in their prospective study consisting of 98 cases that oral clear water on post-operative day 1 was accommodated by 86% of patients, oral liquid diet on post-operative day 2 was accommodated by 70% of patients, and oral semi fluid diet on post-operative day 3 was accommodated by 60% of patients [ 6 ].…”