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Erschienen in: Gastric Cancer 1/2012

01.01.2012 | Original article

Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery

verfasst von: Takanobu Yamada, Tsutomu Hayashi, Haruhiko Cho, Takaki Yoshikawa, Hideki Taniguchi, Ryoji Fukushima, Akira Tsuburaya

Erschienen in: Gastric Cancer | Ausgabe 1/2012

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Abstract

Background

Radical gastrectomy for gastric cancer is among the most invasive procedures in gastrointestinal surgery. Several studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in patients who undergo colorectal surgery, but its value in gastric surgery remains uncertain. The aim of this study was to assess the usefulness of an ERAS protocol for gastric surgery.

Methods

We studied the clinical characteristics, oncological factors, surgical factors, and outcomes in patients who underwent elective radical gastrectomy for gastric cancer before and after the introduction of an ERAS protocol.

Results

The first days of oral intake, oral intake recovery, flatus, and defecation were significantly earlier in the ERAS group (n = 91) than in the conventional care (CONV) group (n = 100). Maximum pain evaluated on a visual analog scale and the number of additional analgesics on demand were significantly less in the ERAS group than in the CONV group. The ratio of the postoperative body weight at 1 week to the preoperative body weight was significantly higher in the ERAS group than in the CONV group (0.95 vs. 0.94, respectively, P = 0.01).

Conclusion

Our results suggest that the ERAS protocol is useful in patients who undergo elective radical gastrectomy.
Literatur
1.
Zurück zum Zitat Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.PubMedCrossRef Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.PubMedCrossRef
2.
Zurück zum Zitat Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.PubMedCrossRef Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.PubMedCrossRef
3.
Zurück zum Zitat Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.PubMedCrossRef Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.PubMedCrossRef
4.
Zurück zum Zitat Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434–40.PubMedCrossRef Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434–40.PubMedCrossRef
5.
Zurück zum Zitat Teeuwen PH, Bleichrodt RP, Strik C, Groenewoud JJ, Brinkert W, van Laarhoven CJ, et al. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg. 2010;14:88–95.PubMedCrossRef Teeuwen PH, Bleichrodt RP, Strik C, Groenewoud JJ, Brinkert W, van Laarhoven CJ, et al. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg. 2010;14:88–95.PubMedCrossRef
6.
Zurück zum Zitat King PM, Blazeby JM, Ewings P, Longman RJ, Kipling RM, Franks PJ, et al. The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis. 2006;8:506–13.PubMedCrossRef King PM, Blazeby JM, Ewings P, Longman RJ, Kipling RM, Franks PJ, et al. The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis. 2006;8:506–13.PubMedCrossRef
7.
Zurück zum Zitat Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery. Proc Nutr Soc. 2003;62:807–11.PubMedCrossRef Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery. Proc Nutr Soc. 2003;62:807–11.PubMedCrossRef
8.
Zurück zum Zitat Mohn AC, Bernardshaw SV, Ristesund SM, Hovde Hansen PE, Røkke O. Enhanced recovery after colorectal surgery. Results from a prospective observational two-centre study. Scand J Surg. 2009;98:155–9.PubMed Mohn AC, Bernardshaw SV, Ristesund SM, Hovde Hansen PE, Røkke O. Enhanced recovery after colorectal surgery. Results from a prospective observational two-centre study. Scand J Surg. 2009;98:155–9.PubMed
9.
Zurück zum Zitat Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1998;1:10–24. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1998;1:10–24.
10.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef
11.
Zurück zum Zitat Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRef Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRef
12.
Zurück zum Zitat Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144:961–9.PubMedCrossRef Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144:961–9.PubMedCrossRef
13.
Zurück zum Zitat Taniguchi H, Sasaki T, Fujita H, Takamori M, Kawasaki R, Momiyama Y, et al. Preoperative fluid and electrolyte management with oral rehydration therapy. J Anesth. 2009;23:222–9.PubMedCrossRef Taniguchi H, Sasaki T, Fujita H, Takamori M, Kawasaki R, Momiyama Y, et al. Preoperative fluid and electrolyte management with oral rehydration therapy. J Anesth. 2009;23:222–9.PubMedCrossRef
14.
Zurück zum Zitat Alvarez Uslar R, Molina H, Torres O, Cancino A. Total gastrectomy with or without abdominal drains. A prospective randomized trial. Rev Esp Enferm Dig. 2005;97:562–9.PubMedCrossRef Alvarez Uslar R, Molina H, Torres O, Cancino A. Total gastrectomy with or without abdominal drains. A prospective randomized trial. Rev Esp Enferm Dig. 2005;97:562–9.PubMedCrossRef
15.
Zurück zum Zitat Wang D, Kong Y, Zhong B, Zhou X, Zhou Y. Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg. 2010;14:620–7.PubMedCrossRef Wang D, Kong Y, Zhong B, Zhou X, Zhou Y. Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg. 2010;14:620–7.PubMedCrossRef
16.
Zurück zum Zitat Carrère N, Seulin P, Julio CH, Bloom E, Gouzi JL, Pradère B. Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg. 2007;31:122–7.PubMedCrossRef Carrère N, Seulin P, Julio CH, Bloom E, Gouzi JL, Pradère B. Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg. 2007;31:122–7.PubMedCrossRef
17.
Zurück zum Zitat Yoo CH, Son BH, Han WK, Pae WK. Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg. 2002;168:379–83.PubMedCrossRef Yoo CH, Son BH, Han WK, Pae WK. Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg. 2002;168:379–83.PubMedCrossRef
18.
Zurück zum Zitat Suehiro T, Matsumata T, Shikada Y, Sugimachi K. Accelerated rehabilitation with early postoperative oral feeding following gastrectomy. Hepatogastroenterology. 2004;51:1852–5.PubMed Suehiro T, Matsumata T, Shikada Y, Sugimachi K. Accelerated rehabilitation with early postoperative oral feeding following gastrectomy. Hepatogastroenterology. 2004;51:1852–5.PubMed
19.
Zurück zum Zitat Soop M, Carlson GL, Hopkinson J, Clarke S, Thorell A, Nygren J, et al. Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol. Br J Surg. 2004;91:1138–45.PubMedCrossRef Soop M, Carlson GL, Hopkinson J, Clarke S, Thorell A, Nygren J, et al. Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol. Br J Surg. 2004;91:1138–45.PubMedCrossRef
20.
Zurück zum Zitat Wagman LD, Baird MF, Bennett CL, Bockenstedt PL, Cataland SR, Fanikos J, et al. Venous thromboembolic disease. NCCN. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2008;6:716–53.PubMed Wagman LD, Baird MF, Bennett CL, Bockenstedt PL, Cataland SR, Fanikos J, et al. Venous thromboembolic disease. NCCN. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2008;6:716–53.PubMed
21.
Zurück zum Zitat Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M, et al. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol. 2007;25:5490–505.PubMedCrossRef Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M, et al. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol. 2007;25:5490–505.PubMedCrossRef
22.
Zurück zum Zitat Jeong O, Ryu SY, Park YK, Kim YJ. The effect of low molecular weight heparin thromboprophylaxis on bleeding complications after gastric cancer surgery. Ann Surg Oncol. 2010;17:2363–9.PubMedCrossRef Jeong O, Ryu SY, Park YK, Kim YJ. The effect of low molecular weight heparin thromboprophylaxis on bleeding complications after gastric cancer surgery. Ann Surg Oncol. 2010;17:2363–9.PubMedCrossRef
23.
Zurück zum Zitat Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparation. Dis Colon Rectum. 2004;47:1397–402.PubMedCrossRef Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparation. Dis Colon Rectum. 2004;47:1397–402.PubMedCrossRef
Metadaten
Titel
Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery
verfasst von
Takanobu Yamada
Tsutomu Hayashi
Haruhiko Cho
Takaki Yoshikawa
Hideki Taniguchi
Ryoji Fukushima
Akira Tsuburaya
Publikationsdatum
01.01.2012
Verlag
Springer Japan
Erschienen in
Gastric Cancer / Ausgabe 1/2012
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-011-0057-x

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