Enhanced recovery after surgery for laparoscopic gastrectomy in gastric cancer: A prospective study

Yanrui Liang, Hao Liu, Li Zhen Nurse, Yu Zhu, Mingli Zhao, Yanfeng Hu, Jiang Yu, Cai Li, Kexuan Liu, Guoxin Li, Yanrui Liang, Hao Liu, Li Zhen Nurse, Yu Zhu, Mingli Zhao, Yanfeng Hu, Jiang Yu, Cai Li, Kexuan Liu, Guoxin Li

Abstract

Background: Laparoscopic distal gastrectomy (LDG) has been highlighted for its safety and better short-term clinical outcomes in treating gastric cancer. However, only a slight reduction of the post-operative hospital stay was observed in gastric cancer patients undergoing LDG with conventional perioperative management, compared to patients undergoing open surgery. Thus, an enhanced recovery after surgery (ERAS) program for LDG is needed to further reduce the post-operative hospital stays. This prospective, open-label, single-arm cohort study aimed to assess the safety and efficacy of the ERAS program for gastric cancer patients undergoing LDG.

Material and methods: All patients with gastric cancer indicated for LDG were consecutively enrolled from December 2016 to January 2018. The ERAS program included short fasting time, effective perioperative pain management, early, goal-oriented ambulation, and oral feeding. The safety assessment was the incidence of post-operative complications, mortality, and readmission in 30 days. The primary efficacy assessment was recovery time defined by post-operative hospital stays and rehabilitative rate on post-operative day 4.

Results: Ninety-eight of 114 patients were finally enrolled. The incidence of post-operative complication, mortality, and readmission in 30 days was 20. 4%, 0%, 7.1%, respectively. The Clavien-Dindo grade III complication rate was 6.1%, while the pulmonary complication rate was 1% only. The median post-operative stay was 6 days (5.0-7.0 days), and the rehabilitative rate on post-operative day 4 was 78%.

Conclusions: The ERAS program might be optimal perioperative management for gastric cancer patients after LDG without compromising safety.

Trial number: NCT03016026.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Post-operative pain score a VAS Visual analogue scale, POD Post-operative day.

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