Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2020; 26(37): 5646-5660
Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5646
Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy
Yu-Long Tian, Shou-Gen Cao, Xiao-Dong Liu, Ze-Qun Li, Gan Liu, Xing-Qi Zhang, Yu-Qi Sun, Xin Zhou, Dao-Sheng Wang, Yan-Bing Zhou
Yu-Long Tian, Shou-Gen Cao, Xiao-Dong Liu, Ze-Qun Li, Gan Liu, Xing-Qi Zhang, Yu-Qi Sun, Xin Zhou, Dao-Sheng Wang, Yan-Bing Zhou, Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Author contributions: Zhou YZ and Tian YL conceived and designed the study; Tian YL, Cao SG, Liu XD, and Li ZQ drafted the manuscript; Sun YQ, Zhou X, and Wang DS completed data management and statistical analysis; all authors have agreed to be responsible for all aspects of the work.
Institutional review board statement: The study was reviewed and approved by the Affiliated Hospital of Qingdao University Ethics Review Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Bing Zhou, MD, Professor, Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266003, Shandong Province, China. zhou_yb2008@126.com
Received: June 9, 2020
Peer-review started: June 9, 2020
First decision: July 25, 2020
Revised: August 2, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: October 7, 2020
Abstract
BACKGROUND

At present, the enhanced recovery after surgery (ERAS) protocol is widely implemented in the field of gastric surgery. However, the effect of the ERAS protocol on the long-term prognosis of gastric cancer has not been reported.

AIM

To compare the effects of ERAS and conventional protocols on short-term outcomes and long-term prognosis after laparoscopic gastrectomy.

METHODS

We retrospectively analyzed the data of 1026 consecutive patients who underwent laparoscopic gastrectomy between 2012 and 2015. The patients were divided into either an ERAS group or a conventional group. The groups were matched in a 1:1 ratio using propensity scores based on covariates that affect cancer survival. The primary outcomes were the 5-year overall and cancer-specific survival rates. The secondary outcomes were the postoperative short-term outcomes and inflammatory indexes.

RESULTS

The patient demographics and baseline characteristics were similar between the two groups after matching. Compared to the conventional group, the ERAS group had a significantly shorter postoperative hospital day (7.09 d vs 8.67 d, P < 0.001), shorter time to first flatus, liquid intake, and ambulation (2.50 d vs 3.40 d, P < 0.001; 1.02 d vs 3.64 d, P < 0.001; 1.47 d vs 2.99 d, P < 0.001, respectively), and lower medical costs ($7621.75 vs $7814.16, P = 0.009). There was a significantly higher rate of postoperative complications among patients in the conventional group than among those in the ERAS group (18.1 vs 12.3, P = 0.030). Regarding inflammatory indexes, the C-reactive protein and procalcitonin levels on postoperative day 3/4 were significantly different between the two groups (P < 0.001 and P = 0.025, respectively). The ERAS protocol was associated with significantly improved 5-year overall survival and cancer-specific survival rates compared with conventional protocol (P = 0.013 and 0.032, respectively). When stratified by tumour stage, only the survival of patients with stage III disease was significantly different between the two groups (P = 0.044).

CONCLUSION

Adherence to the ERAS protocol improves both the short-term outcomes and the 5-year overall survival and cancer-specific survival of patients after laparoscopic gastrectomy.

Keywords: Enhanced recovery after surgery, Conventional management, Laparoscopic gastrectomy, Short-term outcomes, Survival

Core Tip: The results of this retrospective study suggest that enhanced recovery after surgery might be a promising perioperative management protocol for gastric cancer in terms of short-term and long-term outcomes. To the best of our knowledge, this is the first propensity score-matched study to reveal that the enhanced recovery after surgery protocol can improve the 5-year overall survival and cancer-specific survival rates of patients with gastric cancer.