Background
Methods
Patients
ERAS program
Preoperative
Operative day | -1 | 0 | +1 | +2 | +3 | +4 | +5 | +6 | +7 |
Preoperative counseling | Preoperative counseling was held in the outpatient clinic before hospitalization and in the ward after admission. | ||||||||
Pre-medication | Patients do not receive any sedation. | ||||||||
Oral intake | Normal diet until midnight | Oral hydration solution (OS-1®) 3 h before surgery | Drink a water and oral nutrition supplement (Endure Liquid®) | Liquid diet (3 steps up to a soft diet every 2 days) | |||||
Bowel preparation | 1 g magnesium oxide and a New Lecicarbon® suppository | ||||||||
Anesthesia and Analgesics | Combination of epidural analgesia (TH7-11) and general anesthesia during surgery | ||||||||
Continuous thoracic epidural infusion of analgesics after surgery | → | Removing epidural catheter | |||||||
Nonsteroidal anti-inflammatory drug intravenously after surgery twice daily | → | Acetoaminophen three times a daily orally | → | → | → | ||||
Drain and NGT | No drain in distal gastrectomy, one or two drains in total gastrectomy | Removing drain(s) | |||||||
NGT was removed immediately after surgery | |||||||||
Urinary catheter | Removing | ||||||||
ADL | Encourage to sit out of bed for more than 6 h | Encourage to walk the length of the ward | → | → | → | → | → | ||
Antithromboprophylaxis | None | Subcutaneous injection of antithrombotic agent (enoxaparin sodium or fondaparinux) | → | → | None | → | → | ||
X-ray and blood exam. | ○ | ○ | ○ (Check discharge creiteria) |
Perioperative
Postoperative
Data collection (end points)
Results
Patients’ characteristics
Patients(N = 203) | |||
---|---|---|---|
Age (years old)*
| 67(32-84) | ||
Gender | Male | 133 | (65.5%) |
Female | 70 | (34.5%) | |
BMI (kg/m2)*
| 22.2(16.2-31.4) | ||
ECOG-PS | 0 | 177 | (87.2%) |
1 | 26 | (12.8%) | |
2 | 0 | (0.0%) | |
ASA-PS | I | 99 | (48.8%) |
II | 103 | (50.7%) | |
III | 1 | (0.5%) | |
Procedure | Open distal gastrectomy | 67 | (33.0%) |
Laparoscopy-assisted distal gastrectomy | 76 | (37.4%) | |
Open total gastrectomy | 60 | (29.6%) | |
Lymph node dissection | D1,D1+ | 120 | (59.1%) |
D2 | 83 | (40.9%) | |
Reconstruction | Billroth I | 116 | (57.1%) |
Billroth II | 4 | (2.0%) | |
Roux-en Y | 83 | (40.9%) | |
Combined organ resection | yes | 34 | (16.7%) |
no | 169 | (83.3%) | |
Operation time (min.)*
| 179(80-577) | ||
Bleeding (ml)*
| 110(0-1620) | ||
T categories | T1 | 121 | (59.6%) |
T2 | 27 | (13.3%) | |
T3 | 19 | (9.4%) | |
T4 | 36 | (17.7%) | |
N categories | N0 | 131 | (64.5%) |
N1 | 22 | (10.8%) | |
N2 | 19 | (9.4%) | |
N3 | 31 | (15.3%) | |
Stage (UICC TNM 7th) | I | 128 | (63.1%) |
II | 35 | (17.2%) | |
III | 31 | (15.3%) | |
IV | 9 | (4.4%) |
Surgical procedures
Pathological characteristics
Complications and postoperative course
Clavien-Dindo classification | ||
---|---|---|
≥grade 2 n (%) | ≥grade 3 n (%) | |
Pancreas fistula | 7(3.4%) | 2(1.0%) |
Anastomotic leakage | 3(1.5%) | 3(1.5%) |
Ileus | 2(1.0%) | 0(0%) |
Anastomotic stenosis | 2(1.0%) | 1(0.5%) |
Surgical site infection | 2(1.0%) | 0(0%) |
Obstruction | 1(0.5%) | 1(0.5%) |
Pyothorax | 1(0.5%) | 1(0.5%) |
Bleeding | 1(0.5%) | 0(0%) |
Pleural effusion | 1(0.5%) | 0(0%) |
Cholangitis | 1(0.5%) | 0(0%) |
Ascites | 1(0.5%) | 0(0%) |
Toxicoderma | 1(0.5%) | 0(0%) |
Total | 23(11.3%) | 8(3.9%) |
Onset of walk (POD*) | 2(1-4) |
Onset of oral intake (POD*) | 2(1-5) |
Onset of flatus (POD*) | 2(0-5) |
Onset of defecation (POD*) | 4(2-9) |
Delay of meal step up (n(%)) | 10(4.9%) |
Complication CD ≥ grade2 (n(%)) | 23(11.3%) |
Reoperation (n(%)) | 6(3.0%) |
Postoperative hospital stay(days)*
| 9(7-53) |
Readmission (n(%)) | 4(2.0%) |
Mortality (n(%)) | 0(0%) |