Results of a phase 2 study evaluating the safety and efficacy of an enhanced recovery after surgery (ERAS) clinical pathway in patients with early-stage gastric cancer showed that nearly 80% of patients were discharged on postoperative day 4. The findings from this study were published in the Journal of Surgical Oncology.1

Although the implementation of ERAS clinical pathways, designed to shorten postoperative recovery time, has become more common in the setting of early-stage colorectal cancer, the risks and benefits of such an approach in early-stage gastric cancer have not been well established.

This single-arm, open-label study (ClinicalTrials.gov Identifier: NCT01642953) conducted at a single center in Korea prospectively enrolled 133 patients with early-stage gastric cancer scheduled to undergo subtotal gastrectomy using minimally invasive surgery followed by inclusion in an ERAS clinical pathway program.

Perioperative management approaches characterizing this ERAS clinical pathway included early ambulation, introduction of a liquid diet and a soft blended diet on postoperative days 2 and 3, respectively, as well as hospital discharge on postoperative day 4.


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The primary study endpoint was the ERAS clinical pathway completion rate, with secondary study endpoints including 30-day rates of postoperative complications, readmission, and mortality.

Of the 127 adult patients who participated in the ERAS clinical pathway, all had an Eastern Cooperative Oncology Group (ECOG) performance score of 0 or 1, confirmed clinical stage I or IIA gastric adenocarcinoma, and were between 20 and 65 years of age, with a mean age of 48.9 years. Approximately 30% of these patients had 1 or more comorbidities, and more than 90% had pathologic stage I gastric cancer.

Approximately three-quarters of study patients met the criteria for discharge 4 days following surgery, and the ERAS clinical pathway was fully implemented in 77.2% of patients. The 30-day postoperative rate of severe complications was 6.3%, and 6.3% of patients were readmitted to the hospital during that period. No patient deaths occurred within 30 days of surgery.

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By comparison, rates of severe complications, readmission, and death within 30 days following surgery observed in a previously conducted, retrospective study of patients with early-stage gastric cancer undergoing conventional postoperative treatment (ie, introduction of soft blended food on day 5 and discharge on day 6 following surgery) at the same hospital where the ERAS clinical pathway was conducted were 2.2%, 0.7%, and 0%, respectively.2

In their concluding remarks, the study authors called for multicenter studies to evaluate ERAS clinical pathway compared with conventional clinical pathway approaches in the setting of early-stage gastric cancer.

References

  1. Roh CK, Son SY, Lee SY, Hur H, Han SU. Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy [published online January 12, 2020]. J Surg Oncol. doi: 10.1002/jso.25837
  2. Choi JW, Xuan Y, Hur H, Byun CS, Han SU, Cho YK. Outcomes of critical pathway in laparoscopic and open surgical treatments for gastric cancer patients: patients selection for fast‐track program through retrospective analysis. J Gastric Cancer. 2013;13(2):98‐105.

This article originally appeared on Oncology Nurse Advisor