Enhanced Recovery After Surgery for Laparoscopic Gastrectomy for Patients With Gastric Cancer Clinical Trial
Official title:
The Impact of Enhanced Recovery After Surgery (ERAS) Program on Clinical and Immunological Outcomes for Minimally-invasive Gastrectomy: A Randomized Controlled Trial
Over the past two decades, fast track surgery, also known as "enhanced recovery after surgery (ERAS)" has been initiated and developed in colorectal surgery by Kehlet. The program is rapidly gaining popularity due to the significant benefits demonstrated in lowering complication rates and reducing hospital stay and costs. The benefits demonstrated in colorectal surgery by randomized trials and meta-analyses reduced pain, morbidity and hospital stay. Data in gastrectomy however, is scarce. Therefore the aim of this study is to compare the outcomes of laparoscopic gastrectomies with two different perioperative approaches, the traditional and the ERAS approach in a setting of a randomised controlled trial.
Over the past two decades, fast track surgery, also known as "enhanced recovery after surgery
(ERAS)" has been initiated and developed in colorectal surgery by Kehlet. The program is
rapidly gaining popularity due to the significant benefits demonstrated in lowering
complication rates and reducing hospital stay and costs. The benefits demonstrated in
colorectal surgery by randomized trials and meta-analyses reduced pain, morbidity and
hospital stay. Data in gastrectomy however, is scarce. Therefore the aim of this study is to
compare the outcomes of laparoscopic gastrectomies with two different perioperative
approaches, the traditional and the ERAS approach in a setting of a randomised controlled
trial.
ERAS involves an integrated multi-disciplinary program of various medical interventions
involving surgeons, anaesthetists, physiotherapists, dieticians and nurses, aiming at
enhancing postoperative recovery by reducing surgical stress response resulting in earlier
discharge and potentially reduced morbidities. The program focuses on minimising the impact
of surgery on patients' homeostasis. The reduction of postoperative physiological stress by
the attenuation of the neurohormonal response to the surgical intervention not only provides
the basis for a faster recovery, but also diminishes the risk of organ dysfunction and
complications. The ERAS program consists of well-organised pathways of clinical interventions
that begin from out-patient preoperative information, counselling and physical optimization,
proceeding to pre-, intra- and postoperative protocol-driven actions and end with patient
discharge following pre-established criteria. The main pillars of ERAS program consist of
extensive preoperative counselling, non sedative premedication, no preoperative fasting but
with pre-operative carbohydrate loading, tailored anaesthesiology, peri-operative intravenous
fluid restriction, non-opioid pain management, non routine use of nasogastric tubes, early
removal of urinary catheter, and early postoperative feeding and mobilization.
ERAS program will be implemented in one arm and the other arm would be conventional
peri-operative care. This is a randomised controlled study. Apart from clinical outcomes, the
immunological outcomes will also be assessed.
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