Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Desiderio, Jacopo (Department of Digestive Surgery, St. Mary's Hospital, University of Perugia) ;
  • Stewart, Camille L. (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Sun, Virginia (Division of Nursing Research and Education, Department of Population Sciences, Beckman Research Institute, City of Hope National Medical Center) ;
  • Melstrom, Laleh (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Warner, Susanne (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Lee, Byrne (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Schoellhammer, Hans F. (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Trisal, Vijay (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Paz, Benjamin (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Fong, Yuman (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Woo, Yanghee (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center)
  • Received : 2018.06.03
  • Accepted : 2018.07.30
  • Published : 2018.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GCERAS) 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.

Keywords

References

  1. Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 2017;31:3412-3436. https://doi.org/10.1007/s00464-017-5722-7
  2. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011;2:CD007635.
  3. Mortensen K, Nilsson M, Slim K, Schafer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery ($ERAS^{(R)}$) Society recommendations. Br J Surg 2014;101:1209-1229. https://doi.org/10.1002/bjs.9582
  4. Melloul E, Hubner M, Scott M, Snowden C, Prentis J, Dejong CH, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2016;40:2425-2440. https://doi.org/10.1007/s00268-016-3700-1
  5. Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schafer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery ($ERAS^{(R)}$) Society recommendations. Clin Nutr 2012;31:817-830. https://doi.org/10.1016/j.clnu.2012.08.011
  6. Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for pre- and intraoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery ($ERAS^{(R)}$) Society recommendations--Part I. Gynecol Oncol 2016;140:313-322. https://doi.org/10.1016/j.ygyno.2015.11.015
  7. Wang D, Kong Y, Zhong B, Zhou X, Zhou Y. Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg 2010;14:620-627. https://doi.org/10.1007/s11605-009-1139-5
  8. Yamada T, Hayashi T, Cho H, Yoshikawa T, Taniguchi H, Fukushima R, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer 2012;15:34-41. https://doi.org/10.1007/s10120-011-0057-x
  9. Tanaka R, Lee SW, Kawai M, Tashiro K, Kawashima S, Kagota S, et al. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer 2017;20:861-871. https://doi.org/10.1007/s10120-016-0686-1
  10. Sugisawa N, Tokunaga M, Makuuchi R, Miki Y, Tanizawa Y, Bando E, et al. A phase II study of an enhanced recovery after surgery protocol in gastric cancer surgery. Gastric Cancer 2016;19:961-967. https://doi.org/10.1007/s10120-015-0528-6
  11. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123. https://doi.org/10.1007/s10120-011-0042-4
  12. Waddell T, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO-ESSOESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol 2014;40:584-591. https://doi.org/10.1016/j.ejso.2013.09.020
  13. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17:3077-3079. https://doi.org/10.1245/s10434-010-1362-z
  14. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
  15. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 2014;12:1495-1499. https://doi.org/10.1016/j.ijsu.2014.07.013
  16. Smart NJ, White P, Allison AS, Ockrim JB, Kennedy RH, Francis NK. Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model. Colorectal Dis 2012;14:e727-e734. https://doi.org/10.1111/j.1463-1318.2012.03096.x
  17. Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 2011;254:868-875. https://doi.org/10.1097/SLA.0b013e31821fd1ce
  18. Abdikarim I, Cao XY, Li SZ, Zhao YQ, Taupyk Y, Wang Q. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol 2015;21:13339-13344. https://doi.org/10.3748/wjg.v21.i47.13339
  19. Carrere N, Seulin P, Julio CH, Bloom E, Gouzi JL, Pradere B. Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg 2007;31:122-127. https://doi.org/10.1007/s00268-006-0430-9
  20. Suehiro T, Matsumata T, Shikada Y, Sugimachi K. Accelerated rehabilitation with early postoperative oral feeding following gastrectomy. Hepatogastroenterology 2004;51:1852-1855.
  21. Yoo CH, Son BH, Han WK, Pae WK. Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg 2002;168:379-383. https://doi.org/10.1080/110241502320789041
  22. Hirahara N, Matsubara T, Hayashi H, Takai K, Fujii Y, Tajima Y. Significance of prophylactic intraabdominal drain placement after laparoscopic distal gastrectomy for gastric cancer. World J Surg Oncol 2015;13:181. https://doi.org/10.1186/s12957-015-0591-9
  23. Kumar M, Yang SB, Jaiswal VK, Shah JN, Shreshtha M, Gongal R. Is prophylactic placement of drains necessary after subtotal gastrectomy? World J Gastroenterol 2007;13:3738-3741. https://doi.org/10.3748/wjg.v13.i27.3738
  24. Yang Z, Zheng Q, Wang Z. Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Br J Surg 2008;95:809-816. https://doi.org/10.1002/bjs.6198
  25. Han-Geurts IJ, Hop WC, Kok NF, Lim A, Brouwer KJ, Jeekel J. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery. Br J Surg 2007;94:555-561. https://doi.org/10.1002/bjs.5753
  26. Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001;323:773-776. https://doi.org/10.1136/bmj.323.7316.773
  27. Jo DH, Jeong O, Sun JW, Jeong MR, Ryu SY, Park YK. Feasibility study of early oral intake after gastrectomy for gastric carcinoma. J Gastric Cancer 2011;11:101-108. https://doi.org/10.5230/jgc.2011.11.2.101
  28. Scatizzi M, Kroning KC, Boddi V, De Prizio M, Feroci F. Fast-track surgery after laparoscopic colorectal surgery: is it feasible in a general surgery unit? Surgery 2010;147:219-226. https://doi.org/10.1016/j.surg.2009.09.035
  29. Abeles A, Kwasnicki RM, Darzi A. Enhanced recovery after surgery: Current research insights and future direction. World J Gastrointest Surg 2017;9:37-45.

Cited by

  1. Biomarkers for Evaluating the Inflammation Status in Patients with Cancer vol.19, pp.3, 2019, https://doi.org/10.5230/jgc.2019.19.e29
  2. Types of surgical patients enrolled in enhanced recovery after surgery (ERAS) programs in the USA vol.10, pp.1, 2021, https://doi.org/10.1186/s13741-021-00185-5
  3. Implementation of a perioperative‐enhanced recovery protocol in patients undergoing open gastrectomy for gastric cancer vol.124, pp.5, 2018, https://doi.org/10.1002/jso.26591