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Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center

PURPOSE: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GC-ERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implem...

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Autores principales: Desiderio, Jacopo, Stewart, Camille L., Sun, Virginia, Melstrom, Laleh, Warner, Susanne, Lee, Byrne, Schoellhammer, Hans F., Trisal, Vijay, Paz, Benjamin, Fong, Yuman, Woo, Yanghee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Gastric Cancer Association 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160527/
https://www.ncbi.nlm.nih.gov/pubmed/30276000
http://dx.doi.org/10.5230/jgc.2018.18.e24
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author Desiderio, Jacopo
Stewart, Camille L.
Sun, Virginia
Melstrom, Laleh
Warner, Susanne
Lee, Byrne
Schoellhammer, Hans F.
Trisal, Vijay
Paz, Benjamin
Fong, Yuman
Woo, Yanghee
author_facet Desiderio, Jacopo
Stewart, Camille L.
Sun, Virginia
Melstrom, Laleh
Warner, Susanne
Lee, Byrne
Schoellhammer, Hans F.
Trisal, Vijay
Paz, Benjamin
Fong, Yuman
Woo, Yanghee
author_sort Desiderio, Jacopo
collection PubMed
description PURPOSE: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GC-ERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. MATERIALS AND METHODS: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015–October 1, 2016) with the historical control (HC) group (January 1, 2012–October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. RESULTS: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). CONCLUSIONS: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.
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spelling pubmed-61605272018-10-01 Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center Desiderio, Jacopo Stewart, Camille L. Sun, Virginia Melstrom, Laleh Warner, Susanne Lee, Byrne Schoellhammer, Hans F. Trisal, Vijay Paz, Benjamin Fong, Yuman Woo, Yanghee J Gastric Cancer Original Article PURPOSE: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GC-ERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. MATERIALS AND METHODS: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015–October 1, 2016) with the historical control (HC) group (January 1, 2012–October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. RESULTS: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). CONCLUSIONS: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation. The Korean Gastric Cancer Association 2018-09 2018-08-16 /pmc/articles/PMC6160527/ /pubmed/30276000 http://dx.doi.org/10.5230/jgc.2018.18.e24 Text en Copyright © 2018. Korean Gastric Cancer Association https://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Desiderio, Jacopo
Stewart, Camille L.
Sun, Virginia
Melstrom, Laleh
Warner, Susanne
Lee, Byrne
Schoellhammer, Hans F.
Trisal, Vijay
Paz, Benjamin
Fong, Yuman
Woo, Yanghee
Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center
title Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center
title_full Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center
title_fullStr Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center
title_full_unstemmed Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center
title_short Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center
title_sort enhanced recovery after surgery for gastric cancer patients improves clinical outcomes at a us cancer center
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160527/
https://www.ncbi.nlm.nih.gov/pubmed/30276000
http://dx.doi.org/10.5230/jgc.2018.18.e24
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