Enhanced recovery after surgery in gastric cancer: which are the main achievements from the Italian experience?

  • Uberto Fumagalli Romario
  • Jacopo Weindelmayer
  • Andrea Coratti
  • Andrea Cossu
  • Luca Gianotti
  • Stefano Rausei
  • Andrea Sansonetti
  • Stefano De Pascale
  • Italian Group for Enhanced Recovery in Gastric Surgery (ERGS)
Original Article
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Part of the following topical collections:
  1. Gastric Cancer Surgery

Abstract

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.

Keywords

Enhanced recovery after surgery Gastrectomy Gastric cancer 

Notes

Acknowledgements

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.

Informed consent

All patients included in the study signed an informed consent.

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Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  • Uberto Fumagalli Romario
    • 1
  • Jacopo Weindelmayer
    • 2
  • Andrea Coratti
    • 3
  • Andrea Cossu
    • 4
  • Luca Gianotti
    • 5
  • Stefano Rausei
    • 6
  • Andrea Sansonetti
    • 7
  • Stefano De Pascale
    • 1
  • Italian Group for Enhanced Recovery in Gastric Surgery (ERGS)
  1. 1.UO Chirurgia Generale 2, ASST Spedali CiviliBresciaItaly
  2. 2.General and Esophagogastric SurgeryUniversity of VeronaVeronaItaly
  3. 3.Oncologic and Robotic Surgery, Department of OncologyAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  4. 4.Digestive Surgery, San Raffaele HospitalSan Raffaele Vita e Salute UniversityMilanItaly
  5. 5.Department of Surgery, San Gerardo Hospital, School of Medicine and SurgeryMilano-Bicocca UniversityMonzaItaly
  6. 6.General SurgeryVareseItaly
  7. 7.General SurgeryVannini-Figlie di San Camillo HospitalRomeItaly

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