Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5646
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
At present, the enhanced recovery after surgery (ERAS) protocol is widely implemented in the field of gastric surgery. Emerging evidence suggests that the ERAS protocol can influence long-term oncological outcomes after colorectal cancer surgery and elective orthopaedic surgery. However, the effect of the ERAS protocol on the long-term prognosis of gastric cancer has not been reported.
We urgently need to understand that ERAS can improve the long-term prognosis of patients with gastric cancer, so as to standardize our clinical care and improve the terms of ERAS protocol.
The primary aim of this retrospective study was to determine the effect of the ERAS protocol after laparoscopic gastrectomy on long-term survival. The secondary aim was to compare short-term clinical outcomes and inflammatory parameters between the ERAS and conventional protocols.
We retrospectively analyzed the data of 1026 consecutive patients who underwent laparoscopic gastrectomy between 2012 and 2015. Data from these procedures were prospectively collected in a database and then retrospectively reviewed. The patients were divided into either an ERAS group or a conventional group based on the willingness of the patients. 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.
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, P = 0.032, respectively). When stratified by tumour stage, only the survival of patients with stage III disease was significantly different between groups (P = 0.044).
The ERAS protocol has been proven to be a safe and effective perioperative management pathway in the current literature. In particular, the ERAS protocol has shown promising results in improving the survival of patients with gastric cancer after surgery.
This was a single-centre retrospective study; therefore, multicentre randomised controlled trial studies should be performed to verify the reliability of the results. Fortunately, we have registered (Chinese Clinical Trial Registry, CHiCTR1900022438) and started such a project, and patients are currently being recruited. We hope that our data will provide trustworthy evidence that the ERAS pathway improves survival in patients with gastric cancer.