The clinical indication and feasibility of the enhanced recovery protocol for curative gastric cancer surgery: analysis of 147 consecutive experiences.

BACKGROUND: Radical gastrectomy for gastric cancer is one of the most invasive procedures in gastrointestinal surgery. A few studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in radical gastrectomy. The aim of this study was to evaluate the appropriate indication and feasibility of an ERAS protocol in radical gastrectomy.

METHODS: We studied the clinical characteristics in 147 patients managed with an ERAS protocol after radical gastrectomy. Of these patients, the protocol was completely applied to 99 (group I), meaning 48 patients (group II) did not complete the protocol.

RESULTS: The age and ECOG (Eastern Cooperative Oncology Group) status of patients, extent of lymph node dissection, minilaparotomy and insertion of drains were significant influences on compliance to the ERAS protocol. Overall complication rates showed no difference between the two groups; however, local complications were more frequent in group II than group I. Regarding readmission rates within 30 days and after 30 days, there was no significant difference in the incidence and severity grades of causes of readmission between the two groups.

CONCLUSIONS: The results of this study suggest that an ERAS protocol is feasible and safely applicable without increasing the morbidity and readmission rate after radical gastrectomy if it is applied to patients with positive and less invasive procedures.