Short- and long-term outcomes following perioperative ERAS management in patients undergoing minimally invasive radical gastrectomy after neoadjuvant chemotherapy: A single-center retrospective propensity score matching study

Gan Liu; Shougen Cao; Xiaodong Liu; Yulong Tian; Zequn Li; Yuqi Sun; Hao Zhong; Kun Wang; Yanbing Zhou

doi:10.1016/j.ejso.2024.109459

Short- and long-term outcomes following perioperative ERAS management in patients undergoing minimally invasive radical gastrectomy after neoadjuvant chemotherapy: A single-center retrospective propensity score matching study

Eur J Surg Oncol. 2024 Nov 15;51(1):109459. doi: 10.1016/j.ejso.2024.109459. Online ahead of print.

Authors

Gan Liu¹, Shougen Cao¹, Xiaodong Liu¹, Yulong Tian¹, Zequn Li¹, Yuqi Sun¹, Hao Zhong¹, Kun Wang¹, Yanbing Zhou²

Affiliations

¹ Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, Shandong Province, China; Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, No.16, Jiangsu Road, Qingdao, Shandong Province, China.
² Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, Shandong Province, China; Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, No.16, Jiangsu Road, Qingdao, Shandong Province, China. Electronic address: zhouyanbing@qduhospital.cn.

PMID: 39566200
DOI: 10.1016/j.ejso.2024.109459

Abstract

Introduction: Gastric cancer patients receiving neoadjuvant chemotherapy (NACT) are more vulnerable to perioperative stress. Enhanced recovery after surgery (ERAS) is widely used in surgical patients aiming at reducing stress responses. However, whether this approach is safe and feasible for gastric cancer patients received minimally invasive radical gastrectomy after NACT remained determined. So, the objective of this study is to investigate the effects of ERAS for this special group of gastric cancer patients.

Material and methods: The data of gastric cancer patients who underwent minimally invasive radical gastrectomy after NACT were collected. Patients were divided into an ERAS group and a conventional group based on whether they received perioperative ERAS management. Propensity score matching was conducted to eliminate bias. Pre- and postoperative inflammatory and nutritional marker levels, postoperative complications, recovery indices and 3-year OS and RFS were observed.

Results: A total of 252 patients were analyzed after 1:1 PSM, including 126 patients in the ERAS group and 126 in the conventional group. The results showed that the implementation of ERAS significantly reduced the levels of novel inflammatory indicators, improve nutritional status and accelerate postoperative recovery. We found that the 3-year OS (72.2 % vs. 66.7 %) and RFS (67.5 % vs. 61.9 %) in the ERAS group showed an improvement trend compared to those in the traditional group, especially for stage III patients, although these differences were not significant.

Conclusion: The perioperative ERAS program is safe and feasible for gastric cancer patients received minimally invasive radical gastrectomy after NACT.

Keywords: Enhanced recovery after surgery; Gastric cancer; Neoadjuvant chemotherapy.