Multimodal ERAS program in combination with TLDG is the optimal perioperative care in patients with gastric cancer: A prospective randomized clinical trial

Sang Hoon Ahn, MD, Young Suk Park, MD, Dong Jun Shin, MD, Do Joong Park, MD, PhD, Hyung-Ho Kim, MD, PhD. Department of Surgery, Seoul National University Bundang Hospital

Introduction: Although early recovery after surgery (ERAS) program has been shown to enhance postoperative recovery in several surgical fields, there have been no well-designed study in laparoscopic gastric surgery. This study aimed to evaluate the efficacy of ERAS program after totally laparoscopic distal gastrectomy (TLDG) in context of a prospective randomized controlled trial.

Methods: Between Oct 2012 and Aug 2014, 106 patients who had gastric cancer for which TLDG was indicated and randomly assigned on a 1:1 basis to ERAS group (n=46) and conventional group (n=51). The ERAS program received intensive preoperative education, a preoperative carbohydrate solution, sufficient pain control using epidural patient control analgesics, early ambulation, and early oral diet. The primary end point was recovery time, measured with criteria of tolerable diet, safe ambulation, analgesic-free, and afebrile status without complications. Secondary outcome were postoperative hospital stay, complications, quality of life, pain by visual analog scale, and readmission. This study was registered (ID number: NCT 01938313,

Results: Recovery time was faster in the ERAS group, in terms of the rate of recovery on the operative day 2 and 3. (30.4 vs. 0%, P<0.001; 48.2% vs. 33.3%, P=0.037), and the less maximum pain score on the operative day 1, 2, 3, and 4. The possible postoperative hospital stays were shorter in the ERAS group (4.98 vs. 5.69 days, P=0.038), However, there was no difference in the real postoperative hospital stays and complications rates between the 2 groups (5.41 vs. 5.76 days, P=0.295; 13.0 vs. 17.6%, P=0.531). Quality of life were similar in both groups. There were no readmission or mortality.

Conclusion: ERAS program after TLDG results in reduced recovery time without increased complications. These results suggest that a multimodal ERAS program can increase the short-term benefits after TLDG.

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