Laparoscopic Gastrectomy with Enhanced Recovery After Surgery Protocol: Single-Center Experience

Pisarska, Magdalena; Pędziwiatr, Michał; Major, Piotr; Kisielewski, Michał; Migaczewski, Marcin; Rubinkiewicz, Mateusz; Budzyński, Piotr; Przęczek, Krzysztof; Zub-Pokrowiecka, Anna; Budzyński, Andrzej

doi:10.12659/msm.898848

Cited by 29 publications

(24 citation statements)

References 40 publications

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“…The ERAS CP completion rate of 77.2% was within our expected range (75.4‐85.4%) and was comparable to the completion rates in previous studies (60.3%‐79.6%) . Therefore, ERAS CP components might be applicable to patients with gastric cancer.…”

Section: Discussionsupporting

confidence: 83%

“…The ERAS CP completion rate of 77.2% was within our expected range (75.4-85.4%) and was comparable to the completion rates in previous studies (60.3%-79.6%). 15,16 Therefore, ERAS CP components might be applicable to patients with gastric cancer. The components of the ERAS CP that differed most from those of our conventional CP were the start of oral feeding on POD 1 and discharge on POD 4.…”

Section: Discussionmentioning

confidence: 99%

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Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

Roh

Son

Lee

et al. 2020

Journal of Surgical Oncology

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Background We aimed to evaluate the safety and efficacy of a clinical pathway (CP) for enhanced recovery after surgery (ERAS) in gastric cancer patients, including early oral feeding and discharge on postoperative day 4. Methods We performed a prospective, single‐center, phase II clinical trial. Based on proposed indications for an ERAS CP in our retrospective study, we enrolled 133 patients younger than 65 years who were undergoing minimally invasive subtotal gastrectomy. The primary endpoint was the ERAS CP completion rate. Secondary endpoints included complication, mortality, hospital stay, and readmission. Results Among 133 patients, six patients were dropped out from this study. The ERAS CP completion rate (77.2%, 98 of 127) was comparable to the historical control group that completed a conventional CP (85.4%, P = .085). The postoperative complication incidence (13.4%, 15 of 127) was also similar to that of the conventional CP group (9.5%, P = .174). We identified reduced hospital stays (4.7 ± 1.3 vs 7.2±2.3 days; P < .001) and lower hospital costs ($7771 vs 8539; P < .001) in the ERAS CP group compared with the conventional CP group. Conclusions An ERAS CP can be safely and effectively adopted for patients with gastric cancer without increasing the complication rate and could shorten hospital stays. Trial Registration http://ClinicalTrials.gov (NCT01642953).

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

Roh

Son

Lee

et al. 2020

Journal of Surgical Oncology

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“…There is evidence from previous studies in colorectal,6 gastric,7 and orthopedic surgery8 showing that compliance with ERAS pathways is associated with improved clinical outcomes. There is a knowledge gap regarding whether or not the degree of adherence and compliance of each element directly or indirectly impacts on patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery

Iniesta

Lasala

Mena

et al. 2019

International Journal of Gynecological Cancer

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ObjectiveThe aim of this study was to evaluate if varying levels of compliance with an enhanced recovery after surgery (ERAS) protocol impacted post-operative outcomes (length of stay, complications, readmissions, and re-operations) in gynecologic surgery at a tertiary center.MethodsWe included 584 patients who had open gynecologic surgery between November 1, 2014 and December 31, 2016. Patients were categorized into subgroups according to their date of surgery from the time of the ERAS protocol implementation. Patients were categorized by their per cent compliance into two groups:<80% versus ≥80%. We analyzed compliance with the elements of the protocol over time and its relation with post-operative outcomes, length of stay, post-operative complications, readmission, and re-operations rates. We modeled the probability of having a post-operative complication within 30 days of surgery as a function of overall compliance.ResultsOverall compliance was 72.3%. Patients with compliance ≥80% had significantly less complications (P<0.001) and shorter length of stay (P<0.001). Readmission and re-operation rates were not impacted by compliance (P=0.182, P=0.078, respectively). Avoidance of salt water overload, early mobilization, early oral nutrition, and early removal of Foley catheter were significantly associated with less post-operative complications within 30 days.ConclusionsCompliance with an ERAS pathway exceeding 80% was associated with lower complication rates and shorter length of stay without impacting on re-operations or readmissions.

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“…Laparoskopik gastrektomi sonrası komplikasyon oranlarının açık tekniğe göre daha az olduğunu bildiren meta-analiz çalışmalarında bu oran %18-32 arasındadır 30,40 . Bizim çalışmamızda komplikasyon durumunu belirtmek için "Clavien Dindo" sınıflaması kullanıldı.…”

Section: Gereç Ve Yöntemunclassified

“…Literatürdeki serilerde postoperatif 30 günlük mortalite total gastrektomi grubunda %0-8,2 distal gastrektomi grubunda %0-7 olarak verilmiştir ve açık teknik gastrektomiye göre daha düşüktür. 25,26,29,30,42 Bizim çalışmamızda hiçbir hasta da postoperatif mortalite gelişmedi.…”

Section: Gereç Ve Yöntemunclassified

Early results in laparoscopic gastric cancer surgery

Yalav

Topal

Ünal

et al. 2019

Cukurova Medical Journal

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The aim of this study was to evaluate the early results of laparoscopic gastrectomy performed in a university clinic. Materials and Methods: Laparoscopic gastrectomy performed between September 2015 and September 2018 were divided into two groups as total and distal, and evaluated in terms of the technical, pathological and early postoperative complications. Results: Eighteen patients (11 male and 7 female) were included in the study. The mean age was 57.4 and the mean BMI was 26.3. Surgical treatment was prioritised in 13 patients and only five patients underwent neoadjuvant treatment protocols. Total gastrectomy was the preferred surgical method in 14 patients and distal gastrectomy in 4 patients. All patients underwent standard D2 lymph dissection according to tumor localization and 33.2 was the mean number of lymph nodes dissected in the total gastrectomy group; while a mean of 32 lymph nodes were dissected in the distal gastrectomy group. The mean oral start time was 6.4 days in the total gastrectomy group and 2.5 days in the distal gastrectomy group. Duodenal stump leak was detected in 4 patients, esophagojejunostomy leak was detected in 2 patients, while 1 patient had bleeding in the drain location. Conclusion: There are many studies demonstrating the adequacy of laparoscopic gastrectomy and lymphatic dissection. However, we believe that as the experience increases in these surgeries with many technical difficulties and a long learning duration; the operation time will be shortened and the complication rate will decrease. Amaç: Bu çalışmada bir üniversite kliniğinde gerçekleştirilen laparoskopik gastrektomilerin erken dönem sonuçlarının paylaşılması amaçlanmıştır. Gereç ve Yöntem: Eylül 2015-Eylül 2018 tarihleri arasında yapılan laparoskopik gastrektomiler total ve distal olmak üzere iki gruba ayrılmış, teknik, patolojik sonuç ve erken postoperatif komplikasyonlar açısından incelenmiştir. Bulgular: Çalışmaya 11'i erkek, 7'si kadın olmak üzere 18 hasta dahil edilmiştir. Yaş ortalaması 57,4 olup, ortalama BMI 26,3 idi. 13 hastada cerrahi ilk planda tutulmuş sadece beş hastaya neoadjuvan tedavi protokolü uygulanmıştır. Total gastrektomi 14 hastada, distal gastrektomi 4 hastada tercih edilen ameliyat yöntemidir. Tüm hastalara tümör yerleşimine göre standart D2 lenf disseksiyonu uygulandı ve Total gastrektomi grubunda Ortalama 33,2 distal gastrektomi grubunda 32 lenf nodu disseke edildi. Ortalama oral başlama süresi ve Total gastrektomi grubunda 6,4 gün distal gastrektomi grubunda 2,5 gün idi. Duodenal güdük kaçağı 4 hastada, özefagojejunostomi kaçağı 2 hastada tespit edilirken 1 hastada da dren yerinde kanama görüldü. Sonuç: Laparoskopik gastrektomi ve lenfatik disseksiyonun yeterliliğini gösteren birçok çalışma bulunmaktadır. Ancak öğrenim süreci uzun, teknik zorlukları fazla olan bu ameliyatlarda deneyim ve tecrübe arttıkça ameliyat sürenin kısalacağını ve komplikasyon oranının azalacağını düşünmekteyiz.

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Laparoscopic Gastrectomy with Enhanced Recovery After Surgery Protocol: Single-Center Experience

Cited by 29 publications

References 40 publications

Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery

Early results in laparoscopic gastric cancer surgery

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