Feasibility and safety of enhanced recovery after surgery in elderly patients with gastric cancer

doi:10.3748/wjg.v31.i47.113331

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 31, Issue 47

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (23)

All Articles published online

The chart showing PDF series, HTML series, Tables (1-4) series.

Item

Count

PDF

HTML

Tables (1-4)

Sum=49

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=9

Dec 21, 2025 (publication date) through Dec 19, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Dec 21, 2025; 31(47): 113331
Published online Dec 21, 2025. doi: 10.3748/wjg.v31.i47.113331

Feasibility and safety of enhanced recovery after surgery in elderly patients with gastric cancer

Jia-Yu Li, Miao-Miao Ge, Hua-Feng Pan, Gang Wang, Zhi-Wei Jiang

Jia-Yu Li, Miao-Miao Ge, Hua-Feng Pan, Gang Wang, Zhi-Wei Jiang, Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China

Co-corresponding authors: Hua-Feng Pan and Gang Wang.

Author contributions: Pan HF and Wang G contributed equally to this study as co-corresponding authors; Li JY was responsible for manuscript writing, data collection, data analysis, study conception, participated in the design of the study, data interpretation, and project coordination; Ge MM and Pan HF were responsible for data collection, data analysis, participated in study design and assisted in revising the manuscript; Wang G and Jiang ZW were responsible for project administration, data analysis, study conception, participated in the design of the study, supervision; and finalization of the draft.

Supported by The Medical Key Discipline Construction Project of Jiangsu Province, No. ZDXK202251; The Key project of Jiangsu Provincial Hospital Administration of Traditional Chinese Medicine, No. ZD201903; The Project of China Medical Education Association, No. 2022KTZ005; and National Natural Science Foundation of China, No. 81500417.

Institutional review board statement: The study protocol was approved by the Ethics Committee of Affiliated Hospital of Nanjing University of Chinese Medicine, approval No. 2022NL-129-02, and the study was performed in accordance with the Helsinki II declaration.

Informed consent statement: Informed consent was obtained from all the study subjects before enrollment.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Data sharing statement: Data is provided within the manuscript or Supplementary material.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Gang Wang, MD, Associate Professor, Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing 210023, Jiangsu Province, China. gangwang82@163.com

Received: August 22, 2025
Revised: September 22, 2025
Accepted: October 29, 2025
Published online: December 21, 2025
Processing time: 119 Days and 16.3 Hours

Abstract

BACKGROUND

The enhanced recovery after surgery (ERAS) perioperative management framework has been well-documented to improve surgical outcomes and alleviate financial burdens for patients. Against the backdrop of a rapidly aging global population, the incidence of gastric cancer (GC) among elderly individuals continues to increase.

AIM

To validate the feasibility and safety of the ERAS protocol in elderly GC patients, thereby enhancing its evidence-based medical foundation.

METHODS

A retrospective analysis of 161 GC patients who underwent ERAS between January 2022 and January 2024 was conducted. The subjects included 79 young patients (< 65 years) and 82 elderly patients (≥ 65 years). The rates of ERAS compliance, postoperative ventilation time, postoperative hospital stay, reoperation rate, mortality rate, postoperative inflammatory markers C-reactive protein (CRP), white blood cells (WBCs), IL-2, IL-6, and the rate of postoperative complications (anastomotic leakage, incision infection, pulmonary infection) were compared between these two groups.

RESULTS

The incidence of complications in the elderly group was significantly higher than that in the young group, and included hypertension (P = 0.002), diabetes (P = 0.005), respiratory disease (P = 0.034), and heart disease (P = 0.016). In terms of American Society of Anesthesiologists (ASA) grading indicators, the overall ASA grade in the elderly group was biased toward grade II, which was significantly higher than that in the young group (P < 0.001). There was no significant difference in sex, body mass index, preoperative albumin, preoperative WBCs, TNM classification, differentiation, number of lymph node metastasis, and preoperative IL-6 between the two groups. There were no significant differences between the two groups in terms of operative method, surgical approach, conversion to open surgery, operation time, intraoperative bleeding volume, and number of lymph nodes dissected (all P values > 0.05). There were no significant differences between the two groups in ERAS completion rate, reoperation, postoperative first ventilation time, postoperative hospital stays, postoperative anastomotic leakage, postoperative incision infection, postoperative pulmonary infection, and serum inflammatory markers (WBCs, CRP and IL-6) on postoperative day 1 and 3 (all P values > 0.05). No patients in either group died within 30 days after surgery.

CONCLUSION

The application of ERAS protocols in elderly patients is feasible and safe, and its management measures are universally applicable to patients of different ages.

Keywords: Enhanced recovery after surgery; Gastric cancer; Elderly patients; Safety; Postoperative complications

Core Tip: This retrospective analysis of 161 gastric cancer patients confirms both the feasibility and safety of implementing enhanced recovery after surgery (ERAS) protocols for elderly individuals undergoing gastrectomy. Our findings contribute substantively to the evidence base for clinical adoption of ERAS. Furthermore, we describe and analyze key implementation insights regarding perioperative pathway execution in routine practice.