Integration of Neoadjuvant Chemotherapy into the ERAS protocol for Patients with Advanced Gastric Cancer

Abstract

Objective We integrated neoadjuvant chemotherapy (NAC) into the protocol for Enhanced Recovery After Surgery (ERAS) in the management of gastric cancer. This study was aimed at investigating the feasibility and effectiveness of this combined approach. Methods A retrospective cohort study was conducted on patients with gastric cancer undergoing cancer treatment at our Department from January 2016 to June 2019. All patients were compliant with the ERAS protocol perioperatively and were divided into an ERAS group and an ERAS + NAC group for the study. The following parameters were compared between the two groups: TNM staging, the choice of the surgical approach, estimated blood loss, operating time, placement of drainage and catheter, the volume of fluid resuscitation in surgery, the volume of fluid resuscitation on the first postoperative day, time to postoperative ambulation, time to first postoperative flatulence, time to first clear liquid diet, time to puree and soft food diet, time of catheter removal, length of hospitalization after surgery, length of hospitalization, complications, mortality, and 30-day readmission rate. Results This study involved 198 patients who were separated into an ERAS group with 143 patients and an ERAS + NAC group with 55 patients. In comparison with the ERAS group, patients in the ERAS + NAC group were not only pathologically diagnosed with later TNM-stage cancers but were also more likely to undergo total gastrectomy. Further comparison revealed no significant differences in all perioperative parameters related to ERAS. In the ERAS group, the length of hospitalization after surgery was 7.5±5.4 days with a range of 3 to 50 days, the length of hospitalization was 12.5±5.5 days with a range of 9 to 56 days, the incidence rate of complications was 11.2%, and the 30-day readmission rate was zero. In the ERAS + NAC group, the LOHAS was 6.9±3.2 days (4-16 days), the LOH was 11.8±3.1 days (5-21 days), and the complication rate was 10.9%. Both groups had zero 30-day readmission rates and zero deaths. Conclusion The ERAS protocol can be feasibly and effectively applied to gastric cancer patients with later TNM stages. Moreover, NAC can be integrated into the ERAS protocol for patients with advanced gastric cancer.