Enhanced Recovery Program in Laparoscopic Radical Gastrectomy for Gastric Cancer Patients

Chung-wei Lin, MD, Tzu-jung Tsai, MD, Tsung-yen Cheng, MD, Hung-kuang Wei, MD, Chii-ming Chen, MD. Koo Foundation Sun Yat-Sen Cancer Center


INTRODUCTION: Laparoscopic gastrectomy for gastric cancer is technically feasible. The oncologic outcome is comparative with standard surgery and the postoperative recovery is better. The aim of this study is to establish the improvement of postoperative care by applying the Enhanced Recovery Program (ERP) in gastric cancer patients undergo laparoscopic gastrectomy.
METHODS AND PROCEDURES: From August 2008 to August 2011, 47 consecutive gastric cancer patients who received laparoscopic radical gastrectomy with D2 lymph nodes dissection were included. The ERP includes : no epidural or patient controlled analgesic device used, early removal of nasogastric tube on the first postoperative day and then sip water, early mobilization, early resume of regular diet right after flatus passage. Patient characteristics, operative data, and post-operative outcomes were prospectively collected and analyzed.
RESULTS: There were 18 females and 29 males, the mean age was 57 years. The mean operative time was 326 minutes and mean blood loss was 68 ml. The time to first flatus passage was 2.8 days. The mean hospital stay was 6.6 days (range, 5-12). Failure of ERP is defined as need for re-insertion of nasogastric tube, slow progression of resume oral intake and admission longer than 8 days. The failure rate in this 3 years study was 6.4%. Four patients experienced delayed the resume of oral intake because of gastroparesis or ileus in the postoperative period. All of them were treated successfully with conservative method. One patient developed afferent loop syndrome 28 months after operation and managed with emergent exploration. The morbidity and mortality rate was 12.8% and 0%. There was no anastomosis leakage. Median follow-up was 17 months (range, 2-36). There was no cancer recurrence nor disease related death in the follow up period.
CONCLUSION: The application of Enhanced Recovery Program after laparoscopic gastrectomy for gastric cancer is feasible with favorable outcome.


Session Number: Poster – Poster Presentations
Program Number: P240
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