Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 30:101661.
doi: 10.1016/j.accpm.2025.101661. Online ahead of print.

Disease-free survival after gastrectomy is not influenced by eras adherence

Javier Ripollés-Melchor  1 , Ane Abad-Motos  2 , Ana León-Bretscher  3 , Ángel V Espinosa  4 , Sonia Amoza-Pais  5 , Maria Luz Herrero-Bogajo  6 , Alfredo Abad-Gurumeta  7 , Roberto de-la-Plaza-Llama  8 , Patricia Galán-Menéndez  9 , Andrés Zorrilla-Vaca  10 , Rocío González-López  11 , Rosalía Navarro-Pérez  12 , Carlos Jiménez-Viñas  13 , Felipe Carlos Parreño-Manchado  14 , Alicia Ruiz Escobar  7 , Vanessa Concepción-Martín  15 , Gloria Paseiro-Crespo  16 , María Asunción Acosta-Mérida  17 , María Puech-de-Oriol  7 , María Ángeles Mayo-Ossorio  18 , María García-Nebreda  16 , Carlos Chaveli-Diaz  19 , Paula Fernández-Valdes-Bango  7 , José Ramón Torres-Alfonso  20 , Cristina Barragan-Serrano  20 , César Aldecoa  21 ; POWER4 Investigators Group
Affiliations
Free article

Disease-free survival after gastrectomy is not influenced by eras adherence

Javier Ripollés-Melchor et al. Anaesth Crit Care Pain Med. .
Free article

Abstract

Background: Enhanced Recovery After Surgery (ERAS) protocols have been widely adopted in gastric cancer surgery, with consistent benefits in perioperative recovery. However, whether adherence to ERAS influences long-term oncologic outcomes remains unclear. This study aimed to evaluate the association between ERAS adherence and disease-free survival (DFS) following curative-intent gastrectomy.

Methods: This was a prespecified substudy of the POWER4 cohort, a prospective, multicentre investigation of perioperative care and outcomes in patients undergoing elective gastrectomy for gastric cancer. ERAS adherence was assessed using 22 predefined components and analysed as a binary (high vs. low), continuous (per 10-point increment), and quartile-based variable. The primary endpoint was DFS, defined as the time from surgery to recurrence or death. Kaplan-Meier estimates and multivariable Cox models were used to evaluate the association between ERAS adherence and DFS, adjusting for age, sex, ASA, BMI, nutritional risk, anaemia, chronic kidney disease, surgical approach, procedure type, operative time, and tumour stage.

Results: Among 368 patients with complete oncologic follow-up, the median follow-up was 1616 days. Kaplan-Meier curves suggested a trend toward improved DFS with higher ERAS adherence (log-rank p = 0.10 for binary comparison; p = 0.05 across quartiles). In multivariable Cox models, ERAS adherence was not significantly associated with DFS. Prognosis was independently predicted by tumour stage, chronic kidney disease, ASA ≥ III, and total gastrectomy.

Conclusion: In this multicentre cohort, ERAS adherence was not independently associated with long-term DFS after gastrectomy for gastric cancer. Long-term prognosis appeared primarily driven by tumour and patient-related factors rather than perioperative protocol adherence. The study was registered on Clinicaltrials.gov: NCT06790238.

Keywords: Disease-free survival; Enhanced Recovery After Surgery; Gastrectomy; Gastric cancer; Perioperative care.

PubMed Disclaimer

Associated data

LinkOut - more resources