Enhanced recovery (ERAS) protocol in patients undergoing laparoscopic total gastrectomy.

Abstract

IntroductionLaparoscopic technique combined with the ERAS (Enhanced Recovery after Surgery) protocol enables a shorter hospital stay and a lower complication rate. Although it has been widely used in many patients undergoing elective abdominal surgery, especially in patients with colorectal cancer, there are only a few papers describing laparoscopic total gastrectomy and the enhanced recovery protocol in patients with gastric cancer. Minimally invasive gastrectomy is still an uncommon procedure, mostly because of its difficulty.AimTo present the preliminary results of treatment of patients with gastric neoplasms who underwent laparoscopic gastrectomy D2 with perioperative care according to ERAS principles.Material and methodsEleven patients (5 male and 6 female, age 52–77 years) underwent laparoscopic D2 gastrectomy with intracorporeal esophagojejunal anastomosis. In all patients the ERAS protocol was implemented. We analyzed operation time, complications and hospital stay. Additionally we focused on operative technique as well as the perioperative care protocol.ResultsThe mean duration of the procedure was 245 min. There was 1 conversion due to unclear tumor infiltration. Mean hospital stay was 4.6 days. One postoperative complication (central venous catheter sepsis) was reported. Histological analysis confirmed the tentative diagnosis (R0 resection) in 10/11 patients. There were no readmissions.ConclusionsLaparoscopic gastrectomy is a valuable alternative to the classical approach and combined with the ERAS protocol can result in reduced hospital stay. However, due to the small group of patients it is difficult to adequately assess the incidence of early and late complications of the laparoscopic procedures; therefore further research is needed.

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 Europe only a few studies have assessed the influence of multimodal management after gastrectomy. They were focused on laparoscopic gastrectomy or a comparative pre-CP group was missing [15][16][17][18].…”

Laparoscopic assisted total gastrectomy for gastric cancer - operative technique.

“…The reported rates of laparoscopic oesophago-jejunal anastomotic leakage range between 1.8% and 8% [ 6 – 8 ]. In contrast to other authors [ 9 , 10 ], who use a linear stapler for creating the oesophago-jejunal anastomosis, we used the OrVil device. We believe that using the OrVil device may actually decrease the anastomotic leakage rates, allow for a higher anastomosis in the mediastinum and also reduce the rate of positive resection margins.…”

Laparoscopic gastric resections with per oral specimen extraction in treatment of intramural gastric tumors

“…However, conventional laparoscopic techniques usually require enlarging one of the wounds in order to remove the excised material. It increases the risk of trocar site complications, such as infection or incisional hernia [5,6]. In order to reduce that risk, techniques have been developed that enable evacuation of tissue material via natural body orifices [7].…”