Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas

Table 1 Perioperative protocols in the enhanced recovery after surgery and conventional groups

	ERAS group	Conventional group
PreOp	Patient education regarding FTS	Patient education
	Solid food allowed until 6 h before surgery and carbohydrate drinks until 2 h before surgery	No solid food 24 h before surgery and no liquids 12 h before surgery
	No bowel preparation	Mechanical bowel preparation and nasogastric placement performed
Intraoperative	5-trocar laparoscopy-assisted procedure. Non-opioid analgesia after induction of anesthesia. No nasogastric tube or drainage tube used. I.V. fluids were restricted (Ringer’s lactate 20 mL/kg in the first h, after that 6 mL/kg per hour). Vasoactive drugs used if needed	5-trocar laparoscopy-assisted procedure. Routine use of abdominal drainage tubes and placement of catheters I.V. fluids not restricted (Ringer’s lactate 20 mL/kg in the first h, then at the rate of 10-12 mL/kg per hour)
1st PostOp Day	Soluble contrast swallow study is done to check the anastomosis. If intact, fluids are started. Adequate pain control maintained	Keep NPO
	Urinary catheter removed	Removal of urinary catheter
	Patient mobilized out of bed	Mobilization in bed
2nd PostOp Day	Patient started on soft food	Patient is advised to get out of bed
	Continue and increase ambulation. Pain control maintained
3rd PostOp Day	Patient progresses to solid food	Remove nasogastric tube and
	Epidural stopped and acetaminophen started	Liquids started
	Mobilization continued	Encouraged to walk in the ward
		Drains removed
4th PostOp Day	Check discharge criteria	solid food intake

FTS: Fast-track surgery; PostOp: Postoperative; ERAS: Enhanced recovery after surgery.

Table 2 Comparison of clinical characteristics of the patients

	ERAS group	Conventional group	P value
	(n = 30)	(n = 31)
Gender (male/female)	21/9	20/11	0.79
Median age (range in years)	63 ± 12	62 ± 11	0.95
Tumor location			0.94
Upper	10	9
Middle	10	11
Lower	10	11
Length of hospital stay (d)	8.3 ± 1.3	9.9 ± 1.1	< 0.001

ERAS: Enhanced recovery after surgery.

Table 3 Comparison of surgical and oncological factors between the enhanced recovery after surgery group and the conventional group

Variables	ERAS group	Conventional group	P value
	(n = 30)	(n = 31)
Type of surgery			0.72
Distal subtotal gastrectomy D2	21	23
Total gastrectomy D2	9	8
TNM stage			0.92
I	0	0
II	13	13
III	17	18
IV	0	0
Blood loss (mL)	54.5 ± 71.8	64.5 ± 89.7	0.67
Operation time (min)	137.4 ± 28.7	141.5 ± 30.5	0.74
Reconstruction
Billroth I	7	8	0.50
Billroth II	14	10
Roux-en-Y	9	13
Lymph nodes retrieved	39.6 ± 2.3	41.2 ± 3.3	0.42

ERAS: Enhanced recovery after surgery.

Table 4 Postoperative outcomes in days (d)

Variables	ERAS group	Conventional group	P value
	(n = 30)	(n = 31)
Ambulation time	2.6 ± 0.9	3.1 ± 1.0	0.04
Defecation time	3.1 ± 0.7	3.6 ± 0.8	0.01
Food intake	2.9 ± 0.7	3.5 ± 0.8	0.003
POS	6.8 ± 1.1	7.7 ± 1.1	0.002

ERAS: Enhanced recovery after surgery.

Table 5 Complications and readmission in the two groups

Variables	ERAS group	Conventional group	P value
	(n = 30)	(n = 31)
Morbidity
Wound infection	0	1	1.00
Bleeding	0	0	-
Ileus	1	1	1.00
Stenosis	0	0	-
Leakage	0	0	-
Others
Readmission	0	0	-
Mortality	0	0	-

ERAS: Enhanced recovery after surgery.