Enhanced recovery after surgery in gastric cancer: which are the main achievements from the Italian experience? View Full Text


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Article Info

DATE

2018-04-09

AUTHORS

Uberto Fumagalli Romario, Jacopo Weindelmayer, Andrea Coratti, Andrea Cossu, Luca Gianotti, Stefano Rausei, Andrea Sansonetti, Stefano De Pascale, Italian Group for Enhanced Recovery in Gastric Surgery (ERGS)

ABSTRACT

In the last years, the concept of ‘enhanced recovery after surgery’ (ERAS) has become a routine in the perioperative care of patients undergoing colorectal resection. The application of ERAS programs in gastric surgery had a more difficult penetration into clinical practice, mainly for the introduction of radical changes in the traditional postoperative management. The aim of the study was to analyze the rate of compliance to a standardized ERAS protocol in different Italian centers and evaluate the results in terms of postoperative outcomes. From April 2015 to July 2017, a prospective observational study was conducted among seven centers participating in the Italian Group for Research for Gastric Cancer (GIRCG), in patient candidates to elective gastrectomy for cancer. A standardized ERAS perioperative protocol was approved by all centers. Compliance to the protocol was then evaluated and postoperative outcomes (morbidity and mortality rate, duration of hospital stay and readmission rate) were analyzed. Two-hundred and seventy unselected patients operated on for gastric cancer were enrolled. The median age was 73 years; 40.4% of patients were female; 24.1% had a nutritional risk score ≥ 3. Perioperative chemotherapy was used in 23.7% of cases. Total gastrectomy was performed in 57.4% of patients; minimally invasive approach was adopted in 28.1% of patients. Adherence to the protocol varied between 23 and 88% for single items. It was quite low for pre- and intraoperative items, mainly for items related to nutritional care. Postoperative complications occurred in 35.5% of patients, mortality was 0.7%. Median length of hospital stay was 8 days (range 4–72) and the readmission rate was 6.3%. There is a growing attention on the implementation of ERAS protocol for gastric cancer surgery, but several elements of this protocol are still not routinely adopted, among them items regarding nutritional care. More... »

PAGES

257-264

References to SciGraph publications

  • 2010-04-03. Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy in SURGICAL ENDOSCOPY
  • 2017-07-14. Complications after gastrectomy for cancer: Italian perspective in UPDATES IN SURGERY
  • 2010-01-28. Fast-track Surgery Improves Postoperative Recovery in Patients with Gastric Cancer: A Randomized Comparison with Conventional Postoperative Care in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2012-08-02. Preliminary Experience of Fast-Track Surgery Combined with Laparoscopy-Assisted Radical Distal Gastrectomy for Gastric Cancer in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2017-01-06. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial in GASTRIC CANCER
  • 2010-04-24. Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells in SURGICAL ENDOSCOPY
  • 2012-09-01. Safety and Efficacy of Fast-track Surgery in Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Clinical Trial in WORLD JOURNAL OF SURGERY
  • 2017-06-08. The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien–Dindo classification in radical gastric cancer surgery in GASTRIC CANCER
  • 2015-05-06. Feasibility of Fast-Track Surgery in Elderly Patients with Gastric Cancer in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2014-05-13. Risk Factors Associated with Complication Following Gastrectomy for Gastric Cancer: Retrospective Analysis of Prospectively Collected Data Based on the Clavien–Dindo System in JOURNAL OF GASTROINTESTINAL SURGERY
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    http://scigraph.springernature.com/pub.10.1007/s13304-018-0522-8

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    DIMENSIONS

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    35 schema:description In the last years, the concept of ‘enhanced recovery after surgery’ (ERAS) has become a routine in the perioperative care of patients undergoing colorectal resection. The application of ERAS programs in gastric surgery had a more difficult penetration into clinical practice, mainly for the introduction of radical changes in the traditional postoperative management. The aim of the study was to analyze the rate of compliance to a standardized ERAS protocol in different Italian centers and evaluate the results in terms of postoperative outcomes. From April 2015 to July 2017, a prospective observational study was conducted among seven centers participating in the Italian Group for Research for Gastric Cancer (GIRCG), in patient candidates to elective gastrectomy for cancer. A standardized ERAS perioperative protocol was approved by all centers. Compliance to the protocol was then evaluated and postoperative outcomes (morbidity and mortality rate, duration of hospital stay and readmission rate) were analyzed. Two-hundred and seventy unselected patients operated on for gastric cancer were enrolled. The median age was 73 years; 40.4% of patients were female; 24.1% had a nutritional risk score ≥ 3. Perioperative chemotherapy was used in 23.7% of cases. Total gastrectomy was performed in 57.4% of patients; minimally invasive approach was adopted in 28.1% of patients. Adherence to the protocol varied between 23 and 88% for single items. It was quite low for pre- and intraoperative items, mainly for items related to nutritional care. Postoperative complications occurred in 35.5% of patients, mortality was 0.7%. Median length of hospital stay was 8 days (range 4–72) and the readmission rate was 6.3%. There is a growing attention on the implementation of ERAS protocol for gastric cancer surgery, but several elements of this protocol are still not routinely adopted, among them items regarding nutritional care.
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    53 approach
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    55 cancer
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    73 experience
    74 gastrectomy
    75 gastric cancer
    76 gastric cancer surgery
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    81 intraoperative items
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    84 items
    85 last years
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    89 median age
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    91 mortality
    92 nutritional care
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    95 outcomes
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    102 postoperative complications
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