Implementation of a perioperative-enhanced recovery protocol in patients undergoing open gastrectomy for gastric cancer

被引:11
作者
Blumenthaler, Alisa N. [1 ]
Robinson, Kristen A. [1 ]
Kruse, Brittany C. [2 ]
Munder, Kathryn [3 ]
Ikoma, Naruhiko [1 ]
Mansfield, Paul F. [1 ]
Gottumukkala, Vijaya [2 ,4 ]
Kapoor, Ravish [4 ]
Badgwell, Brian D. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Surg Oncol, 1400 Pressler St,FCT17-6010, Houston, TX 77030 USA
[2] Univ Texas MD Anderson Canc Ctr, Inst Canc Care Innovat, Houston, TX 77030 USA
[3] Univ Texas MD Anderson Canc Ctr, Dept Clin Nutr, Houston, TX 77030 USA
[4] Univ Texas MD Anderson Canc Ctr, Dept Anesthesiol & Perioperat Med, Houston, TX 77030 USA
基金
美国国家卫生研究院;
关键词
enhanced recovery after surgery; fast-track surgery; gastrectomy; gastric cancer; stomach neoplasms; LAPAROSCOPIC RADICAL GASTRECTOMY; POSTOPERATIVE RECOVERY; SURGERY; OUTCOMES; COULD;
D O I
10.1002/jso.26591
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background and Objectives The purpose of this study was to compare surgical outcomes before and after implementation of an enhanced recovery protocol (ERP) in gastrectomy for gastric cancer. Methods We included patients who underwent open gastrectomy for gastric cancer before (January 2016 to September 2018) or after (October 2018 to September 2020) ERP implementation. The primary outcome was the postoperative length of stay (LOS). Secondary outcomes included 90-day readmission rates and Clavien-Dindo grade >= 3 complications. Results One hundred patients underwent gastrectomy before (pre-ERP group) and 52 underwent gastrectomy after (ERP group) protocol implementation. Demographic and clinicopathologic characteristics were similar. The median (interquartile range) postoperative LOS was shorter in the ERP group (7.0 days [6.0-8.0] vs. 8.0 days [7.0-11.0]; p < 0.001). The ERP group had similar rates of readmission (33% vs. 24%; p = 0.34) and grade >= 3 complications (19% vs. 19%; p = 1.0) compared to the pre-ERP group, but experienced lower rates of surgical wound complications (0% vs. 19%; p < 0.001). Rates of other complications were similar. Conclusions Implementation of an ERP in patients undergoing open gastrectomy for gastric cancer is feasible and safe and has the potential to decrease postoperative LOS without increasing complication rates.
引用
收藏
页码:780 / 790
页数:11
相关论文
共 22 条
[1]   Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas [J].
Abdikarim, Ikram ;
Cao, Xue-Yuan ;
Li, Shou-Zhen ;
Zhao, Yin-Quan ;
Taupyk, Yerlan ;
Wang, Quan .
WORLD JOURNAL OF GASTROENTEROLOGY, 2015, 21 (47) :13339-13344
[2]   Treatment of localized gastric and gastroesophageal adenocarcinoma: the role of accurate staging and preoperative therapy [J].
Badgwell, Brian ;
Das, Prajnan ;
Ajani, Jaffer .
JOURNAL OF HEMATOLOGY & ONCOLOGY, 2017, 10
[3]   Multimodality Therapy of Localized Gastric Adenocarcinoma [J].
Badgwell, Brian .
JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK, 2016, 14 (10) :1321-1327
[4]   Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center [J].
Desiderio, Jacopo ;
Stewart, Camille L. ;
Sun, Virginia ;
Melstrom, Laleh ;
Warner, Susanne ;
Lee, Byrne ;
Schoellhammer, Hans F. ;
Trisal, Vijay ;
Paz, Benjamin ;
Fong, Yuman ;
Woo, Yanghee .
JOURNAL OF GASTRIC CANCER, 2018, 18 (03) :230-241
[5]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[6]   Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients [J].
Feng, Fan ;
Ji, Gang ;
Li, Ji-Peng ;
Li, Xiao-Hua ;
Shi, Hai ;
Zhao, Zheng-Wei ;
Wu, Guo-Sheng ;
Liu, Xiao-Nan ;
Zhao, Qing-Chuan .
WORLD JOURNAL OF GASTROENTEROLOGY, 2013, 19 (23) :3642-3648
[7]  
Grant MC, 2017, ANN SURG, V265, P68, DOI [10.1097/SLA.0000000000001703, 10.1097/sla.0000000000001703]
[8]   Multimodal strategies to improve surgical outcome [J].
Kehlet, H ;
Wilmore, DW .
AMERICAN JOURNAL OF SURGERY, 2002, 183 (06) :630-641
[9]   Educating surgical oncology providers on perioperative opioid use: A departmental survey 1 year after the intervention [J].
Kim, Bradford J. ;
Lillemoe, Heather A. ;
Newhook, Timothy E. ;
Dewhurst, Whitney L. ;
Arvide, Elsa M. ;
Katz, Matthew H. G. ;
Aloia, Thomas A. ;
Vauthey, Jean-Nicolas ;
Lee, Jeffrey E. ;
Tzeng, Ching-Wei D. .
JOURNAL OF SURGICAL ONCOLOGY, 2020, 122 (03) :547-554
[10]   Enhanced recovery after surgery (ERAS) versus standard recovery for elective gastric cancer surgery: A meta-analysis of randomized controlled trials [J].
Lee, Yung ;
Yu, James ;
Doumouras, Aristithes G. ;
Li, Jennifer ;
Hong, Dennis .
SURGICAL ONCOLOGY-OXFORD, 2020, 32 :75-87