The Clinical Indication and Feasibility of the Enhanced Recovery Protocol for Curative Gastric Cancer Surgery: Analysis of 147 Consecutive Experiences

Lee, Junhyun; Jeon, Hoon

doi:10.1159/000368091

Cited by 10 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It was first tested in colorectal surgery in the late 1990s. Literature from other surgical disciplines shows ERAS patients have decreased hospital stays, pain scores, medical complications, and readmissions after discharge 24–29 . Decreased costs are an additional benefit 30,31 .…”

Section: Discussionmentioning

confidence: 99%

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

et al. 2020

View full text Add to dashboard Cite

Objectives We implement a novel enhanced recovery after surgery (ERAS) protocol with pre‐operative non‐opioid loading, total intravenous anesthesia, multimodal peri‐operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30‐day readmissions. Methods Retrospective cohort study comparing 132 ERAS vs. 66 non‐ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double‐blind fashion by two teams. Results Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P = .004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P = .002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P = .000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P = .010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P = .000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P = .000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P = .000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P = .000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P = .000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P = .017). There were no differences between ERAS and non‐ERAS patients in hospital LOS, ICU LOS, complication rates, and 30‐day readmissions. Conclusion Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates. Level of Evidence 3 Laryngoscope, 131:E792–E799, 2021

show abstract

Section: Discussionmentioning

confidence: 99%

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

et al. 2020

View full text Add to dashboard Cite

show abstract

“…When patients were divided into discharge on POD 4 and discharge after POD 4, the readmission rate tended to be lower in the patients who were discharged on POD 4 (3.8%, 3 of 80) than in the patients who were discharged after POD 4 (10.6%, 5 of 47, P = 0.146). (Table S1) It is known that early discharge is not related to the readmission rate of ERAS for gastric cancer surgery . Prolonged hospitalization did not always ensure complication detection, and it is a risk factor for readmission .…”

Section: Discussionmentioning

confidence: 99%

“…(Table S1) It is known that early discharge is not related to the readmission rate of ERAS for gastric cancer surgery. 8,30,31 Prolonged hospitalization did not always ensure complication detection, and it is a risk factor for readmission. 29,30 In addition, the early discharge has been associated with a better quality of life, as early recovery at home might induce appetite and increase physical activity.…”

Section: Discussionmentioning

confidence: 99%

“…Recent advances in minimally invasive surgery for gastric cancer have decreased morbidity and length of hospital stay when compared with those of open gastrectomy . In addition, efforts have been made to introduce the concept of enhanced recovery after surgery (ERAS) to conventional CPs for gastric cancer surgery to reduce postoperative recovery time …”

Section: Introductionmentioning

confidence: 99%

“…We have previously described the suitable indications for ERAS CP in gastric cancer patients in a study performed at Ajou University Hospital in 2011. 3 Based on those indications, we specified the inclusion criteria for this study as follows: (1) age between 20 and 65 years, (2) histologically proven adenocarcinoma of the stomach, (3) clinical stage I or IIA gastric cancer confirmed by esophagogastroduodenoscopy and abdominal computed tomography (CT), (4) middle to lower third of the tumor expected to be treated by subtotal gastrectomy and R0 resection, (5) possibility for minimally invasive gastrectomy (laparoscopy or robot), (6) Eastern Cooperative Oncology Group performance status of 0 or 1, (7) American Society of Anesthesiology score of class I or II, (8) no possibility for combined resection confirmed by abdominal CT, except gallbladder, (9) and written informed consent obtained before any study-specific assessment. Patients were excluded from this study for the following reasons: (1) clinically apparent distant metastasis, (2) past history of chemotherapy or radiotherapy for gastric cancer, (3) past history of gastric resection for any reason, (4) past history of other malignancy within 5 years, or (5) vulnerable patients who could not communicate.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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).

show abstract

Predictive value of drain amylase content for peripancreatic inflammatory fluid collections after laparoscopic (assisted) distal gastrectomy

et al. 2016

View full text Add to dashboard Cite

show abstract

The Clinical Indication and Feasibility of the Enhanced Recovery Protocol for Curative Gastric Cancer Surgery: Analysis of 147 Consecutive Experiences

Cited by 10 publications

References 29 publications

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

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

Predictive value of drain amylase content for peripancreatic inflammatory fluid collections after laparoscopic (assisted) distal gastrectomy

Contact Info

Product

Resources

About