Journal of Gastric Cancer

  • 제19권1호
  • /
  • Pages.72-82
  • /
  • 2019
  • /
  • 2093-582X(pISSN)
  • /
  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
권호 표지
DOI QR코드

DOI QR Code

Implementation of Enhanced Recovery after Surgery (ERAS) Program in Perioperative Management of Gastric Cancer Surgery: a Nationwide Survey in Korea

  • Jeong, Oh (Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Ho Goon (Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School)
  • 투고 : 2018.11.16
  • 심사 : 2019.01.28
  • 발행 : 2019.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Despite its clinical benefits, enhanced recovery after surgery (ERAS) is less widely implemented for gastric cancer surgery. This nationwide survey investigated the current status of the implementation of ERAS in perioperative care for gastric cancer surgery in South Korea. Materials and Methods: This survey enrolled 89 gastric surgeons from 52 institutions in South Korea. The questionnaire consisted of 24 questions about the implementation of the ERAS protocols in the management of gastric cancer surgery. The survey was carried out using an electronic form sent via email. Results: Of the 89 gastric surgeons, 58 (65.2%) answered that they have knowledge of the concept and details of ERAS, 45 (50.6%) of whom were currently applying ERAS for their patients. Of the ERAS protocols, preoperative education (91.0%), avoidance of preoperative fasting (68.5%), maintenance of intraoperative normothermia (79.8%), thromboprophylaxis (96.5%), early active ambulation (64.4%), and early removal of urinary catheter (68.5%) were relatively well adopted in perioperative care. However, other practices, such as avoidance of preoperative bowel preparation (41.6%), provision of preoperative carbohydrate-rich drink (10.1%), avoidance of routine abdominal drainage (31.4%), epidural anesthesia (15.9%), single-dose prophylactic antibiotics (19.3%), postoperative high oxygen therapy (36.8%), early postoperative diet (14.6%), restricted intravenous fluid administration (53.9%), and application of discharge criteria (57.3%) were not very well adopted for patients. Conclusions: Perioperative management of gastric cancer surgery is largely heterogeneous among gastric surgeons in South Korea. Standard perioperative care based on scientific evidence needs to be established to improve the quality of surgical care and patient outcomes.

키워드

참고문헌

  1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997;78:606-617. https://doi.org/10.1093/bja/78.5.606
  2. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010;29:434-440. https://doi.org/10.1016/j.clnu.2010.01.004
  3. Teeuwen PH, Bleichrodt RP, Strik C, Groenewoud JJ, Brinkert W, van Laarhoven CJ, et al. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg 2010;14:88-95.
  4. King PM, Blazeby JM, Ewings P, Longman RJ, Kipling RM, Franks PJ, et al. The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis 2006;8:506-513. https://doi.org/10.1111/j.1463-1318.2006.00963.x
  5. Qi S, Chen G, Cao P, Hu J, He G, Luo J, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal 2018;32:e22434. https://doi.org/10.1002/jcla.22434
  6. Takagi K, Yoshida R, Yagi T, Umeda Y, Nobuoka D, Kuise T, et al. Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: a randomized controlled trial. Clin Nutr 2018:S0261-5614(18)30002-5.
  7. Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA. Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 2007;24:441-449. https://doi.org/10.1159/000108327
  8. Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J, et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 2007;94:224-231. https://doi.org/10.1002/bjs.5468
  9. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg 2017;152:292-298. https://doi.org/10.1001/jamasurg.2016.4952
  10. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery ($ERAS^{(R)}$) Society recommendations. World J Surg 2013;37:259-284. https://doi.org/10.1007/s00268-012-1772-0
  11. 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. World J Surg 2013;37:240-258. https://doi.org/10.1007/s00268-012-1771-1
  12. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care 2001;4:255-259. https://doi.org/10.1097/00075197-200107000-00002
  13. 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
  14. Lemanu DP, Singh PP, Berridge K, Burr M, Birch C, Babor R, et al. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg 2013;100:482-489. https://doi.org/10.1002/bjs.9026
  15. Kim JW, Kim WS, Cheong JH, Hyung WJ, Choi SH, Noh SH. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg 2012;36:2879-2887. https://doi.org/10.1007/s00268-012-1741-7
  16. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017;20:1-19. https://doi.org/10.1007/s10120-016-0622-4
  17. Liu HP, Zhang YC, Zhang YL, Yin LN, Wang J. Drain versus no-drain after gastrectomy for patients with advanced gastric cancer: systematic review and meta-analysis. Dig Surg 2011;28:178-189. https://doi.org/10.1159/000323954
  18. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2005:CD004929.
  19. 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
  20. Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparation. Dis Colon Rectum 2004;47:1397-1402. https://doi.org/10.1007/s10350-004-0592-1
  21. Zaouter C, Kaneva P, Carli F. Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med 2009;34:542-548. https://doi.org/10.1097/AAP.0b013e3181ae9fac
  22. Benoist S, Panis Y, Denet C, Mauvais F, Mariani P, Valleur P. Optimal duration of urinary drainage after rectal resection: a randomized controlled trial. Surgery 1999;125:135-141. https://doi.org/10.1016/S0039-6060(99)70256-4
  23. Ljungqvist O, Soreide E. Preoperative fasting. Br J Surg 2003;90:400-406. https://doi.org/10.1002/bjs.4066
  24. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 2011;114:495-511. https://doi.org/10.1097/ALN.0b013e3181fcbfd9
  25. Svanfeldt M, Thorell A, Hausel J, Soop M, Rooyackers O, Nygren J, et al. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. Br J Surg 2007;94:1342-1350. https://doi.org/10.1002/bjs.5919
  26. Kurz A, Sessler DI, Lenhardt R; Study of Wound Infection and Temperature Group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996;334:1209-1215. https://doi.org/10.1056/NEJM199605093341901
  27. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630-641. https://doi.org/10.1016/S0002-9610(02)00866-8
  28. 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
  29. Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev 2006:CD004080.
  30. Soop M, Carlson GL, Hopkinson J, Clarke S, Thorell A, Nygren J, et al. Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol. Br J Surg 2004;91:1138-1145. https://doi.org/10.1002/bjs.4642
  31. Charoenkwan K, Phillipson G, Vutyavanich T. Early versus delayed (traditional) oral fluids and food for reducing complications after major abdominal gynaecologic surgery. Cochrane Database Syst Rev 2007:CD004508.
  32. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002;359:1812-1818. https://doi.org/10.1016/S0140-6736(02)08711-1
  33. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 2002;89:622-632. https://doi.org/10.1093/bja/aef220
  34. MacKay G, Fearon K, McConnachie A, Serpell MG, Molloy RG, O'Dwyer PJ. Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery. Br J Surg 2006;93:1469-1474. https://doi.org/10.1002/bjs.5593
  35. Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003;238:641-648. https://doi.org/10.1097/01.sla.0000094387.50865.23
  36. Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002;97:820-826. https://doi.org/10.1097/00000542-200210000-00012
  37. Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C. Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 2002;57:845-849. https://doi.org/10.1046/j.1365-2044.2002.02708.x
  38. Marret E, Remy C, Bonnet F; Postoperative Pain Forum Group. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 2007;94:665-673. https://doi.org/10.1002/bjs.5825
  39. Zutshi M, Delaney CP, Senagore AJ, Mekhail N, Lewis B, Connor JT, et al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 2005;189:268-272. https://doi.org/10.1016/j.amjsurg.2004.11.012
  40. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002;359:1276-1282. https://doi.org/10.1016/S0140-6736(02)08266-1

피인용 문헌

  1. Nutritional management of patients undergoing laparoscopic surgery for gastric cancer based on the concept of rapid rehabilitation vol.27, pp.22, 2019, https://doi.org/10.11569/wcjd.v27.i22.1349
  2. Survey and Analysis of the Application and Implementations of Enhanced Recovery after Surgery (ERAS) Program for Surgical Patients in the Major Hospitals in Korea vol.10, pp.2, 2019, https://doi.org/10.18858/smn.2019.10.2.32
  3. 加速康复外科和日间手术模式在胸外科中的应用现状及发展前景 vol.23, pp.9, 2020, https://doi.org/10.3779/j.issn.1009-3419.2020.102.08
  4. Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy vol.26, pp.37, 2019, https://doi.org/10.3748/wjg.v26.i37.5646
  5. Changing trends of clinicopathologic features and survival duration after surgery for gastric cancer in Northeast China vol.12, pp.10, 2020, https://doi.org/10.4251/wjgo.v12.i10.1119
  6. Abdominal Drainage in the Prevention and Management of Major Intra-Abdominal Complications after Total Gastrectomy for Gastric Carcinoma vol.20, pp.4, 2019, https://doi.org/10.5230/jgc.2020.20.e32
  7. Preoperative Intake of Carbohydrate-Rich Drinks Is Associated With Postoperative Pulmonary Complications in Patients After Gastric Cancer Surgery vol.105, pp.1, 2019, https://doi.org/10.9738/intsurg-d-20-00007.1
  8. Background for the introduction of enhanced recovery after surgery and patient outcomes vol.64, pp.12, 2021, https://doi.org/10.5124/jkma.2021.64.12.801
  9. Perception and implementation status of enhanced recovery after surgery vol.64, pp.12, 2021, https://doi.org/10.5124/jkma.2021.64.12.826
  10. Randomized Controlled Trial Comparing the Short-term Outcomes of Enhanced Recovery After Surgery and Conventional Care in Laparoscopic Distal Gastrectomy (GISSG1901) vol.275, pp.1, 2019, https://doi.org/10.1097/sla.0000000000004908