J Gastric Cancer.  2018 Sep;18(3):230-241. 10.5230/jgc.2018.18.e24.

Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center

• Desiderio
• Stewart CL
• Sun V
• Melstrom L
• Warner S
• Lee B
• Schoellhammer HF
• Trisal V
• Paz B
• Fong Y
• Woo Y

• KMID: 2420783
• DOI: http://doi.org/10.5230/jgc.2018.18.e24

Abstract

PURPOSE
Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GC-ERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States.
MATERIALS AND METHODS
We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015-October 1, 2016) with the historical control (HC) group (January 1, 2012-October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy.
RESULTS
Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P < 0.001) and intraabdominal drain placement (25% vs. 85%, P < 0.001), faster advancement of diet (P < 0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively).
CONCLUSIONS
The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.

Keyword

Gastrectomy; Gastric cancer; Minimally invasive surgical procedures; Return of function

MeSH Terms

Asia
Body Mass Index
Comorbidity
Diet
Gastrectomy
Humans
Length of Stay
Medical Records
Minimally Invasive Surgical Procedures
Propensity Score
Prospective Studies
Stomach Neoplasms*
United States

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