Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea.
Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea.
Ann Surg Oncol. 2018 Aug;25(8):2366-2373. doi: 10.1245/s10434-018-6524-4. Epub 2018 May 22.
Enhanced recovery after surgery (ERAS) programs have gained widespread acceptance in different fields of major surgery. However, most elements of perioperative care in ERAS are based on practices that originated from colorectal surgery. This study investigated compliance with the main elements of ERAS for patients undergoing gastrectomy for gastric carcinoma.
This phase 2 study enrolled 168 patients undergoing elective gastrectomy for gastric carcinoma. An ERAS program consisting of 18 main elements was implemented, and compliance with each element was evaluated (ClinicalTrials.gov, NCT01653496).
Distal gastrectomy was performed for 142 patients (84.5%) and total gastrectomy for 26 patients (10.1%). Laparoscopic surgery was performed for 141 patients (86%). The postoperative morbidity rate was 9.5%, and the mortality rate was 0%. The rates of compliance with the 18 main elements of ERAS ranged from 88.1 to 100%. The lowest compliance rate was observed in the restriction of intravenous fluid element (88.1%). Overall, all ERAS elements were successfully applied for 122 patients (72.6%). In the multivariate analysis, the significant factors that adversely affected compliance with ERAS were surgery during the early study period [odds ratio (OR) 0.39; p = 0.038], open surgery (OR 0.15; p <0.001), and postoperative morbidity (OR 0.16; p = 0.003).
Most elements of ERAS can be successfully applied for patients undergoing gastrectomy for gastric carcinoma. Multimodal collaboration between providers is essential to achieve proper application of ERAS.
加速康复外科（ERAS）方案已在多个主要外科领域得到广泛认可。然而，ERAS 围手术期护理的大多数内容都基于起源于结直肠手术的实践。本研究旨在调查接受胃癌根治术的患者实施 ERAS 的主要内容的依从性。
本 2 期研究纳入了 168 例接受择期胃癌根治术的患者。实施了一个包含 18 个主要内容的 ERAS 方案，并对每个内容的依从性进行了评估（ClinicalTrials.gov，NCT01653496）。
142 例患者（84.5%）接受了远端胃切除术，26 例患者（10.1%）接受了全胃切除术。141 例患者（86%）接受了腹腔镜手术。术后发病率为 9.5%，死亡率为 0%。ERAS 18 个主要内容的依从率为 88.1%至 100%。依从率最低的是限制静脉补液内容（88.1%）。总体而言，122 例患者（72.6%）成功实施了所有 ERAS 内容。多变量分析显示，对 ERAS 依从性产生不利影响的显著因素包括研究早期的手术[比值比（OR）0.39；p=0.038]、开放性手术（OR 0.15；p<0.001）和术后并发症（OR 0.16；p=0.003）。
大多数 ERAS 内容可成功应用于接受胃癌根治术的患者。提供者之间的多模式合作对于 ERAS 的适当应用至关重要。
