Tang YH, Zhang J. Clinical effect of enhanced recovery after surgery based on multidisciplinary collaboration model in postoperative gastric cancer surgery. World J Gastrointest Surg 2025; 17(7): 105387 [PMID: 40740921 DOI: 10.4240/wjgs.v17.i7.105387]
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03656249
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August 01, 2025, 13:53
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Reader Comments:
The challenge of optimizing postoperative recovery and long-term outcomes in patients undergoing gastric cancer (GC) surgery continues to pose significant clinical and logistical hurdles, despite advancements in surgical techniques and perioperative care (1). In this study, Tang and Zhang present valuable findings on the integration of enhanced recovery after surgery (ERAS) protocols with a multidisciplinary collaboration model, highlighting its potential to improve gastrointestinal recovery, psychological status, and patient satisfaction in the postoperative setting.
In their retrospective analysis of GC patients undergoing radical gastrectomy, the authors demonstrated that those managed under a multidisciplinary ERAS model experienced significantly faster recovery of gastrointestinal function—as evidenced by earlier first flatus and defecation—alongside shorter postoperative hospital stays and reduced complication rates. Recent studies have further supported the beneficial effects of ERAS protocols on gastrointestinal function in patients with GC (2,3). In addition to these objective clinical metrics, the study also reported improvements in subjective outcomes, including lower anxiety and depression scores, better sleep quality, and higher overall patient satisfaction, suggesting that integrated perioperative care may positively impact both physiological and psychological recovery trajectories. Their work contributes to the extensive and growing body of literature demonstrating the benefits of ERAS in gastrointestinal surgery (4,5).
Despite the encouraging findings, several important methodological concerns warrant further discussion. First, the study is retrospective in design, yet the number of patients in the ERAS group and the control group was matched at a strict 1:1 ratio (n=60 each), a distribution that appears non-random and unexplained. Such parity raises the possibility of selective inclusion or post hoc group assignment, which can introduce bias and compromise the internal validity of the findings. Second, the authors did not specify whether any patients initially considered for ERAS management were excluded due to protocol deviation, medical contraindications, or perioperative complications. Without a transparent description of patient selection and exclusion criteria for the ERAS cohort, it is difficult to assess the generalizability and applicability of the results to broader clinical populations.
A significant limitation lies in its retrospective, single-center design. Without randomization or stratified analysis of critical confounders—such as comorbidity profiles, tumor stage, surgical approach, and baseline nutritional status—the validity of causal inferences is limited (8). Additionally, the absence of detailed compliance metrics for ERAS components (e.g., early feeding, ambulation targets, analgesia protocols) restricts reproducibility and hinders the evaluation of individual contributors to the observed outcomes.
In conclusion, this study reinforces the value of multidisciplinary ERAS pathways in GC surgery.
References
1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians 2024 doi 10.3322/caac.21834.
2. Lee HJ, Kim J, Koo BW, Suh YS, Lee JM, Han DS, et al. Survey of Perioperative Practices in Gastric Cancer Surgery for Establishing an Enhanced Recovery After Surgery Program Across 10 Tertiary Hospitals in South Korea. J Gastric Cancer 2025;25(3):424-36 doi 10.5230/jgc.2025.25.e27.
3. Tian Q, Wang H, Guo T, Yao B, Liu Y, Zhu B. The efficacy and safety of enhanced recovery after surgery (ERAS) Program in laparoscopic distal gastrectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Med 2024;56(1):2306194 doi 10.1080/07853890.2024.2306194.
4. Wang J, Yuan T, Shi J. Application of Medical-Nursing Integration Multidisciplinary-Assisted Surgical Wound Nursing Mode in Improving the Quality of Wound Treatment. Emerg Med Int 2022;2022:9299529 doi 10.1155/2022/9299529.
5. Lee HJ, Kim J, Yoon SH, Kong SH, Kim WH, Park DJ, et al. Effectiveness of ERAS program on postoperative recovery after gastric cancer surgery: a randomized clinical trial. Int J Surg 2025;111(5):3306-13 doi 10.1097/js9.0000000000002328.
6. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997;78(5):606-17 doi 10.1093/bja/78.5.606.
7. Choi CI, Park JK, Chung JH, Lee SH, Hwang SH, Jeon TY, et al. The application of enhanced recovery after surgery protocol after distal gastrectomy for patients with gastric cancer: a prospective randomized clinical trial. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2024;28(6):791-8 doi 10.1016/j.gassur.2024.02.032.
8. Tian Y, Cao S, Li L, Yu W, Ding Y, Zhang G, et al. Three-year Survival Outcomes of Patients With Enhanced Recovery After Surgery Versus Conventional Care in Laparoscopic Distal Gastrectomy: The GISSG1901 Randomized Clinical Trial. Annals of surgery 2025;282(1):46-55 doi 10.1097/sla.0000000000006603.
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