Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Abstract

Since the late 1990s, perioperative care through the enhanced recovery after surgery (ERAS, European Society for Clinical Nutrition and Metabolism [ESPEN]) program has spread. ERAS protocols aim to reduce surgical complications, improving postoperative outcomes and thereby saving resources by addressing various clinical elements through a multidisciplinary approach or based on evidence. In the field of gastric cancer, the philosophy of ERAS has gradually become accepted and, in 2014, consensus guidelines for enhanced recovery after gastrectomy were published. These guidelines consist of “procedure‐specific” guidelines and “general (not procedure‐specific) enhanced recovery items.” In this review, we focused on the procedure‐specific guidelines and tried to update the contents of every element of the procedure‐specific guidelines. The procedure‐specific guidelines consist of the following eight elements: “Preoperative nutrition,” “Preoperative oral pharmaconutrition,” “Access (of gastrectomy),” “Wound catheters and transversus abdominis plane block,” “Nasogastric/Nasojejunal decompression,” “Perianastomotic drains,” “Early postoperative diet and artificial nutrition,” and “Audit.” On reviewing papers supporting these elements, it was reconfirmed that the recommendations of the guidelines are pertinent and valid. Four meta‐analyses concerning the evaluation of ERAS protocols for gastric cancer were included in this review. Every study showed that the ERAS protocol reduced the cost and duration of hospital stay without increasing surgical complication rates, suggesting that ERAS is effective for gastric cancer surgery. However, it cannot be said that ERAS has achieved full penetration in Japan because most evidence is established in Western countries. Future studies must focus on developing a new ERAS protocols appropriate to Japanese conditions of gastric cancer.

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“…In patients with moderate and severe malnutrition, nutritional input is required before any type of treatment, for 7-14 days, in order to reduce morbidity and mortality. Patients initially submitted only to neoadjuvant treatment, also have indication of nutritional therapy, particularly those with food intake below 70% of estimated energy spent 13 , 46 .…”

Risk factors for surgical-site infections after radical gastrectomy for gastric cancer: a study in China

“…Based on the guidelines for enhanced recovery after surgery, [ 25 , 26 ] TPN is not recommended as a method of nutritional support after upper gastrointestinal surgery. The existing routine of nil-by-mouth for upper gastrointestinal surgery remains unchallenged.…”