Randomized Controlled Trial Comparing the Short-term Outcomes of Enhanced Recovery After Surgery and Conventional Care in Laparoscopic Distal Gastrectomy (GISSG1901)

Abstract

Objective: This study aimed to compare the effects of ERAS and conventional programs on short-term outcomes after LDG. Summary of Background Data: Currently, the ERAS program is broadly applied in surgical areas. Although several benefits of LDG with the ERAS program have been covered, high-level evidence is still limited, specifically in advanced gastric cancer. Methods: The present study was designed as a randomized, multicenter, unblinded trial. The enrollment criteria included histologically confirmed cT2-4aN0-3M0 gastric adenocarcinoma. Postoperative complications, mortality, readmission, medical costs, recovery, and laboratory outcomes were compared between the ERAS and conventional groups. Results: Between April 2019 and May 2020, 400 consecutive patients who met the enrollment criteria were enrolled. They were randomly allocated to either the ERAS group (n = 200) or the conventional group (n = 200). After excluding patients who did not undergo surgery or gastrectomy, 370 patients were analyzed. The patient demographic characteristics were not different between the 2 groups. The conventional group had a significantly longer allowed day of discharge and postoperative hospital stay (6.96 vs 5.83 days, P < 0.001; 8.85 vs 7.27 days, P < 0.001); a longer time to first flatus, liquid intake and ambulation (3.37 vs 2.52 days, P < 0.001; 3.09 vs 1.13 days, P < 0.001; 2.85 vs 1.38 days, P < 0.001, respectively); and higher medical costs (6826 vs 6328 $, P = 0.027) than the ERAS group. Additionally, patients in the ERAS group were more likely to initiate adjuvant chemotherapy earlier (29 vs 32 days, P = 0.035). There was no significant difference in postoperative complications or in the mortality or readmission rates. Regarding laboratory outcomes, the procalcitonin and C-reactive protein levels on postoperative day 3 were significantly lower and the hemoglobin levels on postoperative day 5 were significantly higher in the ERAS group than in the conventional group. Conclusion: The ERAS program provides a faster recovery, a shorter postoperative hospitalization length, and lower medical costs after LDG without increasing complication and readmission rates. Moreover, enhanced recovery in the ERAS group enables early initiation of adjuvant chemotherapy.

Application of enhanced recovery after surgery in perioperative patients undergoing laparoscopic surgery for gastric cancer: A meta-analysis

“…1). [20][21][22][23][24][25][26][27][28][29][30] The quality of the included literature was mainly of low and medium risk, with high reference value (Fig. 2).…”

“…Compared with traditional open surgery, laparoscopic surgery itself has the advantages of less trauma and faster postoperative recovery. [42] Besides, this procedure does not require preoperative bowel preparation and allows patients to eat liquid food and glucose to supplement Wang Y 2021 [20] 44 54.5 ± 5.4 25/19 44 55.2 ± 6.0 20/24 (1) (2) (3) (4) Kang SH 2018 [21] 46 56.3 ± 10.4 33/13 51 54.5 ± 12.6 38/13 (1) (3) Weindelmayer J 2021 [22] 248 60-76 154/94 103 60-78 55/48 (3) (4) Jeong O 2021 [23] 219 61.9 ± 11.4 146/73 219 61.2 ± 10.8 145/74 (3) (4) Tian Y 2022 [24] 186 58.3 ± 10.5 129/57 184 58.6 ± 10.9 124/60 (1) (2) (3) (4) (5) Xiao SM 2022 [25] 50 72. (3) (4) (5) Desiderio J 2018 [26] 20 61.0 ± 16.0 8/12 40 63.0 ± 14.0 19/21 (1) (2) (3) (4) Chen JX 2022 [27] 23 67.…”

Development and validation of nomograms for predicting overall survival and cancer-specific survival in elderly patients with locally advanced gastric cancer: a population-based study

“…Apart from racial and age differences, another reason may be that all patients received standardized perioperative care based on the standardized Enhanced Recovery After Surgery (ERAS) protocol among the three externally verified centres. Over the past two years, ERAS has developed appreciably and has become an important part of the perioperative treatment of gastric cancer [ 40 ]. Our preliminary study showed that implementation of ERAS principles has the potential to reduce surgical stress, reduce the incidence of postoperative adverse events and improve patient long-term prognosis, particularly for elderly patients [ 41 , 42 ].…”

Effect of preoperative immunonutrition on postoperative short-term clinical outcomes in patients with gastric cancer cachexia: a prospective randomized controlled trial

“…All enrolled patients adhered to the enhanced recovery after surgery (ERAS) program, which is the routine care mode utilized in our center (19). The ERAS program consists of preoperative pre-rehabilitation therapy, no preoperative mechanical bowel preparation, fasting for 6 hours before surgery, orally glucose infusion until 2 hours before surgery, intraoperative target-oriented liquid management, local anesthesia in the deep incision, general anesthesia combined with epidural anesthesia, early removal of urinary catheter and abdominal drainage tube, early bedside activity, multimodal postoperative analgesia, and sequential enteral nutrition treatment after awakening.…”