Fumagalli Romario Uberto, Weindelmayer Jacopo, Coratti Andrea, Cossu Andrea, Gianotti Luca, Rausei Stefano, Sansonetti Andrea, De Pascale Stefano
UO Chirurgia Generale 2, ASST Spedali Civili, Piazza Spedali Civili 1, 25123, Brescia, Italy.
General and Esophagogastric Surgery, University of Verona, Verona, Italy.
Updates Surg. 2018 Jun;70(2):257-264. doi: 10.1007/s13304-018-0522-8. Epub 2018 Apr 9.
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.
在过去几年中，“术后加速康复”（ERAS）理念已成为结直肠切除患者围手术期护理的常规操作。ERAS方案在胃癌手术中的应用在临床实践中的推广较为困难，主要是因为传统术后管理引入了根本性变革。本研究的目的是分析意大利不同中心对标准化ERAS方案的依从率，并评估术后结果。2015年4月至2017年7月，对参与意大利胃癌研究组（GIRCG）的七个中心中拟行择期胃癌切除术的患者进行了一项前瞻性观察研究。所有中心均批准了标准化的ERAS围手术期方案。然后评估对该方案的依从性，并分析术后结果（发病率和死亡率、住院时间和再入院率）。纳入了270例未经选择的接受胃癌手术的患者。中位年龄为73岁；40.4%的患者为女性；24.1%的患者营养风险评分≥3。23.7%的病例采用了围手术期化疗。57.4%的患者进行了全胃切除术；28.1%的患者采用了微创方法。单项的方案依从率在23%至88%之间。术前和术中项目的依从率相当低，主要是与营养护理相关的项目。35.5%的患者发生了术后并发症，死亡率为0.7%。中位住院时间为8天（范围4 - 72天），再入院率为6.3%。人们对胃癌手术实施ERAS方案的关注度日益提高，但该方案的几个要素仍未常规采用，其中包括与营养护理相关的项目。
