Enhanced recovery after surgery in gastric cancer: which are the main achievements from the Italian experience?
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In the last years, the concept of ‘enhanced recovery after surgery’ (ERAS) has become a routine in the perioperative care of patients undergoing colorectal resection. The application of ERAS programs in gastric surgery had a more difficult penetration into clinical practice, mainly for the introduction of radical changes in the traditional postoperative management. The aim of the study was to analyze the rate of compliance to a standardized ERAS protocol in different Italian centers and evaluate the results in terms of postoperative outcomes. From April 2015 to July 2017, a prospective observational study was conducted among seven centers participating in the Italian Group for Research for Gastric Cancer (GIRCG), in patient candidates to elective gastrectomy for cancer. A standardized ERAS perioperative protocol was approved by all centers. Compliance to the protocol was then evaluated and postoperative outcomes (morbidity and mortality rate, duration of hospital stay and readmission rate) were analyzed. Two-hundred and seventy unselected patients operated on for gastric cancer were enrolled. The median age was 73 years; 40.4% of patients were female; 24.1% had a nutritional risk score ≥ 3. Perioperative chemotherapy was used in 23.7% of cases. Total gastrectomy was performed in 57.4% of patients; minimally invasive approach was adopted in 28.1% of patients. Adherence to the protocol varied between 23 and 88% for single items. It was quite low for pre- and intraoperative items, mainly for items related to nutritional care. Postoperative complications occurred in 35.5% of patients, mortality was 0.7%. Median length of hospital stay was 8 days (range 4–72) and the readmission rate was 6.3%. There is a growing attention on the implementation of ERAS protocol for gastric cancer surgery, but several elements of this protocol are still not routinely adopted, among them items regarding nutritional care.
KeywordsEnhanced recovery after surgery Gastrectomy Gastric cancer
The list of the authors of the Italian Group for Enhanced Recovery in Gastric Surgery: Stefano De Pascale and Uberto Fumagalli Romario—ASST Spedali Civili—Brescia. Jacopo Weindelmayer, Valentina Mengardo and Giovanni De Manzoni—University of Verona. Lapo Bencini and Andrea Coratti—Azienda Ospedaliero-Universitaria Careggi—Firenze. Andrea Cossu, Paolo Parise and Riccardo Rosati—Vita e Salute University—Milan. Eleonora Colciago, Giovanni Colombo and Luca Gianotti—San Gerardo Hospital, Monza. Federica Galli and Stefano Rausei—General Surgery, Varese. Francesco Casella and Andrea Sansonetti—Vannini—Figlie di San Camillo Hospital—Rome.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
This article does not contain any experimental studies with human participants or animals performed by any of the authors.
All patients included in the study signed an informed consent.
- 7.Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P, The Surgical Cooperative Group (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet 347(9007):995–999CrossRefPubMedGoogle Scholar
- 9.Lee KG, Lee HJ, Yang JY, Oh SY, Bard S, Suh YS, Kong SH, Yang HK (2014) Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien–Dindo system. J Gastrointest Surg 18(7):1269–1277CrossRefPubMedGoogle Scholar
- 10.Kim TH, Suh YS, Huh YJ et al (2017) The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery. Gastric Cancer. https://doi.org/10.1007/s10120-017-0728-3 (epub ahead of print)
- 13.He ZG, Tang Y, Wu HG, Wei B, Chen L, Li R (2010) Benefits of perioperative fast- track surgery program on clinical outcome in patients with gastric cancer. Chin J Clin Nutr 18(1):29–32Google Scholar
- 21.Liu G, Jian F, Wang X, Chen L (2016) Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial. OncoTargets Ther 9:3345–3351Google Scholar
- 22.Tanaka R, Lee SW, Kawai M et al (2017) Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer. https://doi.org/10.1007/s10120-016-0686-1 (epub ahead of print)