Division of Oncologic and Mini-Invasive General Surgery, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy.
Updates Surg. 2021 Oct;73(5):1857-1865. doi: 10.1007/s13304-021-01093-5. Epub 2021 May 20.
Adherence to an ERAS program guarantees an evidence-based approach for patient care, but the compliance to ERAS in patients undergoing surgery for gastric cancer in Western countries has not been clearly investigated. Our Institution has implemented an ERAS pathway (EP) for gastric surgery, composed of 24 items, since December 2016. We retrospectively analyzed the data of all consecutive patients undergoing surgery with curative intent for gastric cancer between January 2017 and December 2019 at our Institution, and were eligible for our EP. The primary endpoint was patients' compliance to the EP. Secondary endpoints were patients' adherence to each ERAS item and detection of variables associated with compliance failure. Seventy-three patients were included. Among these, 75.3% completed the EP, with a median number of items accomplished per patient of 21. Items with critical adherence were restrictive intraoperative fluid infusion (37%), avoidance of abdominal drain (14%), first clear liquid intake (67%), first solid food intake (48%). At univariate analysis age > 75 years, ASA > 2 and total gastrectomy were associated with failure to complete the EP. At multivariate analysis, ASA Score > 2 was the only preoperative factor associated with EP failure. Application of an ERAS program for malignant gastric surgery seems to be feasible with an acceptable completion rate in a tertiary referral Western centre. Preoperative factors, such as old age, advanced stage at diagnosis and neoadjuvant chemotherapy should not be considered as exclusion criteria for ERAS.
实施加速康复外科（ERAS）方案可确保为患者提供循证医学治疗，但在西方国家，接受胃癌手术的患者对 ERAS 的依从性尚未得到明确调查。自 2016 年 12 月以来，我们医院为胃癌手术实施了包含 24 项内容的 ERAS 路径（EP）。我们回顾性分析了 2017 年 1 月至 2019 年 12 月期间在我院接受根治性手术的所有连续胃癌患者的数据，这些患者符合我们的 EP 标准。主要终点是患者对 EP 的依从性。次要终点是患者对每个 ERAS 项目的依从性以及检测与依从性失败相关的变量。共纳入 73 例患者。其中，75.3%的患者完成了 EP，每位患者完成的项目中位数为 21 项。关键依从性项目为限制术中液体输注（37%）、避免腹部引流（14%）、首次摄入清亮液体（67%）、首次摄入固体食物（48%）。单因素分析显示，年龄＞75 岁、ASA＞2 级和全胃切除术与 EP 失败有关。多因素分析显示，术前 ASA 评分＞2 级是与 EP 失败相关的唯一术前因素。在三级转诊西方中心，应用恶性胃外科的 ERAS 方案似乎是可行的，完成率可接受。年龄较大、诊断时分期较晚和新辅助化疗等术前因素不应被视为 ERAS 的排除标准。
