Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy

Laparoscopic gastrectomy is evolving. With the increasing expertise and experience of oncologic surgeons in the minimally invasive surgery for gastric cancer, the indication for laparoscopic gastrectomy is expanding to advanced cases. Many studies have demonstrated the benefits of minimally invasive surgery, including reduced risk of surgery-related injury, reduced blood loss, less pain, and earlier recovery. In order to establish concrete evidence for the suitability of minimal invasive surgery for gastric cancer, many multicenter RCTs, comparing the short- and long-term outcomes of laparoscopic versus open surgery, are in progress. Advances in laparoscopic gastrectomy are moving toward increasingly minimally invasive approaches that enable the improvement of the quality of life of patients, without compromising on oncologic safety.

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High preoperative modified frailty index has a negative impact on short- and long-term outcomes of octogenarians with gastric cancer after laparoscopic gastrectomy

Surgical Endoscopy ◽

10.1007/s00464-018-6085-4 ◽

2018 ◽

Vol 32 (5) ◽

pp. 2193-2200 ◽

Cited By ~ 4

Author(s):

Jun Lu ◽

Hua-Long Zheng ◽

Ping Li ◽

Jian-Wei Xie ◽

Jia-bin Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Negative Impact ◽

Frailty Index ◽

Long Term Outcomes ◽

Modified Frailty Index ◽

Short And Long Term

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Short- and long-term outcomes following laparoscopic gastrectomy for advanced gastric cancer compared with open gastrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.369 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 369-369

Author(s):

Kazuaki Shibuya ◽

Hideki Kawamura ◽

Yosuke Ohno ◽

Nobuki Ichikawa ◽

Tadashi Yoshida ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Clinical Stage ◽

Stage Ii ◽

Open Gastrectomy ◽

Long Term Outcomes ◽

Significant Difference ◽

Short And Long Term

369 Background: To investigate the oncological feasibility and technical safety of laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer. Methods: 186 advanced gastric cancer patients treated by gastrectomy with D2 lymphadenectomy were eligible for inclusion including those with invasion into the muscularis propria, subserosa, and serosa without involvement of other organs, and stages N0–2 and M0. We retrospectively compared the short- and-long term outcomes between laparoscopic gastrectomy and open gastrectomy. Results: We analyzed short-term outcomes by comparing distal- with total gastrectomy results. We found no significant difference for distal gastrectomy for postoperative morbidity (laparoscopic vs. open: n = 4 (4.6%) vs. n = 1 (3.6%); p= 1.00). We also found no significant difference in postoperative morbidity for total gastrectomy (laparoscopic vs. open: n = 2 (4.0%) vs. n = 1 (4.0%); p= 1.00). No deaths occurred in any group. The entire cohort analysis revealed no statistically significant differences in overall- or recurrence-free survival between the laparoscopic and open groups. For overall survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III ( p= 0.29 and 0.27, respectively), and for pathological stage II or III ( p= 0.88 and 0.86, respectively). For recurrence-free survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III ( p= 0.63 and 0.60, respectively), and for pathological stage II or III (p = 0.98 and 0.72, respectively). Conclusions: Laparscopic gastrectomy for advanced gastric cancer compared favorably with open gastrectomy regarding short- and long-term outcomes. Clinical trial information: 160907.

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Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries — a systematic review

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02306-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Qianyun Pang ◽

Liping Duan ◽

Yan Jiang ◽

Hongliang Liu

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Long Term Outcomes ◽

High Adherence ◽

Eras Protocol

Abstract Background Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted. Methods The Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: “ERAS” or “enhanced recovery” or “fast track”, “oncologic outcome”, “recurrence”, “metastasis”, “long-term outcomes”, “survival”, and “cancer surgery”. The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed. Results A total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy. Conclusions The use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival.

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Pre-habilitation in Enhanced Recovery After Surgery Programs: A New Potential for Balneology and Physical Medicine to Benefit Patients

Acta Balneologica ◽

10.36740/abal201902102 ◽

2019 ◽

Vol 61 (2) ◽

pp. 78-80

Author(s):

David Ferson

Keyword(s):

Quality Of Care ◽

21St Century ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Surgical Patient ◽

Physical Medicine ◽

Long Term Outcomes ◽

Multidisciplinary Teamwork

Medicine in the 21st century is becoming more integrated and less episodic. The ERAS programs have demonstrated that developing an organized, multidisciplinary teamwork approach to surgical patient care can significantly improve the quality of care and reduce complications. The next step in further improving the ERAS programs and potentially positively influencing the long-term outcomes for the patients is optimal conditioning and preparation before the surgery.

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