Implementation of the ERAS program in gastric surgery: a nationwide survey in Italy

Abstract

Enhanced recovery after surgery (ERAS) programs have been developed by combining several evidence-based techniques for perioperative care, with the intention of reducing the stress response and organ dysfunction, thus allowing improved clinical results. ERAS programs have been widely adopted for colorectal surgery; however, their adoption for upper gastrointestinal surgery has been challenging even though good results have been reported in the literature. Our intent was to investigate the adoption of ERAS programs for resective gastric surgery in Italy. A survey was conducted among 20 departments of surgery belonging to the Italian Group for Research on Gastric Cancer (GC). Analysis of our survey showed that several evidence-based practices and many items of the ERAS guidelines for gastric surgery are not implemented in real practice in Italian centers dedicated to GC. This situation may be related to the hesitation of surgeons to introduce radical changes to the traditional postoperative management after gastrectomy. A multidisciplinary approach to the perioperative care of these patients is not routinely applied in many Italian centers. A strict collaboration of all clinicians involved in the perioperative care of patients undergoing gastrectomy for GC is key for the future implementation of ERAS in gastric surgery in our departments.

Textbook Neoadjuvant Outcome—Novel Composite Measure of Oncological Outcomes among Gastric Cancer Patients Undergoing Multimodal Treatment

“…It is estimated that even 65% of surgical patients present some degree of malnutrition, and adherence to ERAS protocol improved 5-year survival in colorectal cancer patients correlated with early nutritional delivery in the postoperative period [73]. However, its adoption in gastrointestinal surgery remains underrepresented, largely due to distinct traditional post-gastrectomy management practices [74]. Additionally, the impact of ERAS is evaluated after the surgery, and the tool assessing patients' condition in the post-NAC setting is lacking.…”