ENHANCED RECOVERY AFTER SURGERY (ERAS) IN GASTRIC CANCER SURGERY: A SYSTEMATIC REVIEW

Abstract

The aim of this study was to clarify the efficacy of the ERAS protocol for gastric cancer surgery.We provided a systematic review of randomized controlled trials and retrospective cohort studies involving either enhanced recovery after surgery (ERAS) or fast track surgery (FTS) for patients after gastrectomy for cancer. EMBASE, Pubmed, Cochrane were searched. Primary outcomes were early postoperative morbidity, mortality and length of hospital stay. Inclusion criteria were: studies published from 2010 to 2019, in English, at least 60 patients enrolled, with a detailed protocol of enhanced recovery. Secondary outcomes: early postoperative results (pain scale, mobilization, first defecation, soft food taken) and cost. 10 trials were eligible for review. Compared with conventional care group, ERAS led to decreased incidence of overall complications and didn't influence the leakage rate. ERAS implementation resulted in rapid postoperative recovery of gastric cancer patients after gastrectomy. It was associated with less pain, early defecation, early start of soft food intake. The readmission rate was comparable to conventional care group. Also, ERAS showed economical benefits because of decreasing the length of hospital stay, decreased cost of treatment and same readmission rate. Conclusion: Our systematic literature review showed that ERAS programs are safe and feasible for gastric cancer patient after gastrectomy. Future prospective randomized clinical trials are necessary to detect the role of ERAS programs in European gastric cancer patients, elderly and «high risk» patients.