Background
Gastric cancer is the second leading cause of cancer-related death worldwide. Complete surgical resection plays the most important role in the cure of gastric cancer; however, surgery for gastric cancer remains a high-risk procedure with clinically significant postoperative stress, complications, and sequelae. Morbidity and mortality from radical gastrectomy range from 9.1–46.0% and 0–13%, respectively.
Enhanced recovery after surgery (ERAS) programs have been proposed to maintain physiological function and facilitate postoperative recovery. In the following studies, ERAS was considered to reduce rates of morbidity, shorten length of hospital stay. ERAS programs have many elements, including preoperative education, preoperative carbohydrate loading, omission of bowel preparation, epidural analgesia without opioids, early postoperative enteral feeding, early mobilization of patients, and thrombotic prophylaxis. In colorectal surgery, several studies have reported that ERAS programs are feasible and useful.
We previously demonstrated that an ERAS protocol is useful in patients who undergo elective radical gastrectomy. Other studies have reported that ERAS programs or fast-track surgery in gastric surgery can accelerate postoperative rehabilitation. However, the number of patients assessed in these studies was small. In addition, some studies found that the incidence of some postoperative complications, especially nausea, vomiting, and postoperative ileus, tended to be higher in the ERAS group than in the conventional group, suggesting that ERAS programs might increase the risk of some complications after gastric surgery. Because of these controversial results, it is necessary to confirm the feasibility of ERAS programs in gastric surgery.
The present study evaluated whether an ERAS program was feasible in more than 200 patients who underwent gastric surgery. Emphasis was placed on postoperative gastrointestinal complications.