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. 2020 Dec;15(4):553-559.
doi: 10.5114/wiitm.2020.92833. Epub 2020 Feb 4.

High compliance to ERAS protocol does not improve overall survival in patients treated for resectable advanced gastric cancer

Mateusz Rubinkiewicz  1 , Magdalena Pisarska  1 , Piotr Zarzycki  1 , Katarzyna Truszkiewicz  1 , Jan Witowski  1 , Michael Su  2 , Robert Kupis  2 , Anna Gajdosz  2 , Michał Pędziwiatr  1
Affiliations

High compliance to ERAS protocol does not improve overall survival in patients treated for resectable advanced gastric cancer

Mateusz Rubinkiewicz et al. Wideochir Inne Tech Maloinwazyjne. 2020 Dec.

Abstract

Introduction: The ERAS (Enhanced Recovery after Surgery) protocol revolutionized perioperative care for gastrointestinal surgical procedures. However, little is known about the association between adherence to the ERAS protocol in gastric cancer surgery and the oncological outcome.

Aim: To explore the relation between adherence to the ERAS protocol and the oncological outcome in gastric cancer patients.

Material and methods: We performed a retrospective analysis of a prospectively collected database of patients treated for gastric cancer between 2013 and 2016. All patients were treated perioperatively with a 14-item ERAS protocol. Every patient underwent regular follow-up every 3 months for 3 years after surgery. 80% compliance to the ERAS protocol was the goal during perioperative care. Based on the level of compliance, patients were divided into group 1 and group 2 (compliance of ≥ 80% and < 80%, respectively).

Results: Compliance to the ERAS protocol was not a risk factor for diminished overall survival - probability of 3-year survival was 63% in group 1 and 56% in group 2 (p = 0.75). The proportional Cox model revealed that only stage III gastric cancer was a risk factor of poor prognosis in patients operated on for gastric cancer (HR = 7.89, 95% CI: 2.96-20.89; p = 0.0001).

Conclusions: High adherence to the ERAS protocol did not improve overall survival in our 3-year observation. Only the stage of the disease, according to the AJCC classification, was identified as a risk factor for poor prognosis.

Keywords: adherence; enhanced recovery after surgery; gastrectomy; gastric cancer; laparoscopy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patients flow through the study
Figure 2
Figure 2
Kaplan-Meier survival estimates according to ERAS protocol adherence
Figure 3
Figure 3
Kaplan-Meier survival estimates according to stage of the disease
See this image and copyright information in PMC

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