Rubinkiewicz Mateusz, Pisarska Magdalena, Zarzycki Piotr, Truszkiewicz Katarzyna, Witowski Jan, Su Michael, Kupis Robert, Gajdosz Anna, Pędziwiatr Michał
2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2020 Dec;15(4):553-559. doi: 10.5114/wiitm.2020.92833. Epub 2020 Feb 4.
The ERAS (Enhanced Recovery after Surgery) protocol revolutionized perioperative care for gastrointestinal surgical procedures. However, little is known about the association between adherence to the ERAS protocol in gastric cancer surgery and the oncological outcome.
To explore the relation between adherence to the ERAS protocol and the oncological outcome in gastric cancer patients.
We performed a retrospective analysis of a prospectively collected database of patients treated for gastric cancer between 2013 and 2016. All patients were treated perioperatively with a 14-item ERAS protocol. Every patient underwent regular follow-up every 3 months for 3 years after surgery. 80% compliance to the ERAS protocol was the goal during perioperative care. Based on the level of compliance, patients were divided into group 1 and group 2 (compliance of ≥ 80% and < 80%, respectively).
Compliance to the ERAS protocol was not a risk factor for diminished overall survival - probability of 3-year survival was 63% in group 1 and 56% in group 2 (p = 0.75). The proportional Cox model revealed that only stage III gastric cancer was a risk factor of poor prognosis in patients operated on for gastric cancer (HR = 7.89, 95% CI: 2.96-20.89; p = 0.0001).
High adherence to the ERAS protocol did not improve overall survival in our 3-year observation. Only the stage of the disease, according to the AJCC classification, was identified as a risk factor for poor prognosis.
加速康复外科（ERAS）方案彻底改变了胃肠道手术的围手术期护理。然而，对于胃癌手术中遵循ERAS方案与肿瘤学结局之间的关联，人们知之甚少。
探讨胃癌患者遵循ERAS方案与肿瘤学结局之间的关系。
我们对2013年至2016年期间前瞻性收集的胃癌患者数据库进行了回顾性分析。所有患者在围手术期均采用14项ERAS方案进行治疗。术后每位患者每3个月进行一次定期随访，持续3年。围手术期护理的目标是80%的ERAS方案依从率。根据依从程度，患者被分为第1组和第2组（分别为依从率≥80%和<80%）。
遵循ERAS方案并非总生存降低的危险因素——第1组3年生存率为63%，第2组为56%（p = 0.75）。比例风险模型显示，仅III期胃癌是接受胃癌手术患者预后不良的危险因素（HR = 7.89，95%CI：2.96 - 20.89；p = 0.0001）。
在我们为期3年的观察中，高度遵循ERAS方案并未改善总生存。根据美国癌症联合委员会（AJCC）分类，仅疾病分期被确定为预后不良的危险因素。
