Laparoscopic Radical Gastrectomy for Resectable Advanced Gastric Cancer Within Enhanced Recovery Programs: A Prospective Randomized Controlled Trial

Abstract

Background: Enhanced recovery programs have become an important focus of perioperative management. A few studies have demonstrated the efficacy of an enhanced recovery after surgery (ERAS, which includes optimized pain control, restricted I.V. fluids, early initiation of postoperative oral feeding, and enforced mobilization) protocol in patients undergoing radical gastrectomy. We investigated the feasibility and safety of laparoscopic radical gastrectomy within ERAS programs.

Methods: In this single-center prospective randomized controlled trial conducted between September 2013 and August 2014, 149 consecutive locally advanced gastric cancer patients (T2-4, any N, M0) diagnosed by the CT scanning were allocated to either ERAS group (N = 73) or conventional pathway group (N = 76). The same surgical technique was used in both groups, that is, laparoscopic gastrectomy with D2 lymphadenectomy and R0 resection. Intergroup differences were evaluated for clinical parameters and C-reactive protein for testing tissue injury.

Results: ERAS combined with laparoscopic gastrectomy was observed in our study. Recovery parameters such as time to return to normal diet (days) 1.90 ± 0.71 versus 3.52 ± 0.81, P = .003 and time to the first defecation (days) 2.97 ± 1.23 versus 5.20 ± 1.81, P = .015 were measured. The post hospital stay (days) in ERAS and the conventional care group were 6.38 ± 2.04 and 8.62 ± 2.87, P < .001, respectively. No statistically significant intergroup differences were observed in terms of postoperative complications and C-reactive protein levels. One patient in the ERAS group was readmitted because of anastomotic leakage. No instances of deaths were reported during the 30-day follow-up period.

Conclusion: This study demonstrates the feasibility and safety of ERAS protocol in advanced gastric cancer patients undergoing laparoscopic radical gastrectomy and was associated with shorter duration of hospital stay. ( Clinicaltrials.gov Identifier No NCT02348229).

Keywords: C-reactive protein; advanced gastric cancer; enhanced recovery after surgery; laparoscopic gastrectomy.