Assessment of the Effectiveness of Enhanced Recovery after Surgery (ERAS) Programs for Gastrectomy Iraqi Patients

Authors

  • Dr. Husham Fadhil Hussein M.B.Ch.B., F.I.B.M.S. \ (General Surgery), Iraqi Ministry of Health, Al-Karkh Health Department, Al-Yarmouk Teaching Hospital, Baghdad, Iraq
  • Dr. Louai Abdul Muneam Ali Al Hilli M.B.Ch.B., C.A.B.S., D.S. \ (TIKRET) \ (General and Laparoscopic Surgery), Iraqi Ministry of Health, Al-Karkh Health Department, Al-Yarmouk Teaching Hospital, Baghdad, Iraq
  • Dr. Ammar Muhammed Kadhem M.B.Ch.B., F.I.B.M.S., C.A.B.S. \ (General Surgery), Iraqi Ministry of Health, Al-Karkh Health Department, Al-Yarmouk Teaching Hospital, Baghdad, Iraq

Keywords:

Effectiveness of the Enhanced Recovery After Surgery (ERAS) program, Gastric cancer, Gastrectomy surgery, Complications, Hospital stays

Abstract

BACKGROUND: Over the past decades, the ERAS program has shown great benefit and efficacy in managing gastrectomy for patients with gastric cancer.

AIM: This study aimed to ascertain and enrol the benefits of the ERAS programme in terms of clinical outcomes for patients undergoing gastrectomy for gastric cancer.

PATIENTS AND METHODS: In different hospitals in Iraq, clinical and demographic data were collected for patients with gastric cancer who underwent Laparoscopic distal gastrectomy (LDG). This included 96 patients between March 2023 and October 2024. The clinical outcomes of patients were recorded before and after gastric cancer surgery. The effectiveness of the Enhanced Recovery After Surgery (ERAS) program was evaluated, as well as their impact on patients.

RESULTS: The current findings indicate that the gastric antrum was the most prevalent location of the tumour in patients undergoing laparoscopic distal gastrectomy (LDG) for gastric cancer. This was observed in 48.96% of the total number of patients. The operative time for laparoscopic distal gastrectomy (LDG) ranged from 2 to 4 cases, with an intraoperative bleeding volume of 140. The mean volume was 57 ± 13.63 mL, and the proportion of cases undergoing lymphadenectomy (%) D2 was 54. The mean length of stay was 5.2 ± 0.3 days, and four cases were transferred to the ICU. The 60-day mortality rate was only one case. The proportion of complications classified as mild was 28 cases, moderate was 16 cases, and severe was seven cases. In terms of the success of the ERAS Compliance Score on gastrectomy patients, we demonstrated that multimodal pain management had an average score of 87.44 ± 5.80, postoperative complications had an average score of 75.02 ± 5.88, postoperative nutrition had an average score of 88.74 ± 3.92, and patient satisfaction had an average score of 81.66 ± 5.78.

CONCLUSION: Even though there were no changes in morbidity and mortality rates, ERAS for gastrectomy enhanced the recovery of patients' mortality rate and minimized hospitalization costs.

References

Machlowska J, Baj J, Sitarz M, et al. Gastric cancer: epidemiology, risk factors, classification, genomic characteristics, and treatment strategies. Int J Mol Sci. 2020;21 (11):1.

Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021;71 (3):209–15.

Smith JK, McPhee JT, Hill JS, et al. National outcomes after gastric resection for neoplasm. Arch Surg. 2007;142 (4):387–393.

Johnston FM, Beckman M. Updates on the management of gastric cancer. Curr Oncol Rep. 2019;21 (8):67.

Zhu Z, Li L, Xu J, et al. Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review. World J Surg Oncol. 2020;18 (1):126.

Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263 (1):28–35.

Lee HJ, Hyung WJ, Yang HK, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg. 2019;270 (6):983– 991.

Japanese Gastric Cancer Association. Japanese gastric cancer association. Japanese Gastric Cancer Treatment Guidelines 2018 (5th edition). Gastric Cancer. 2021;24 (1):1–21.

Huscher CGS, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer. Ann Surg. 2005;241 (2):232–237.

Adachi Y, Suematsu T, Shiraishi N, et al. Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg. 1999;229 (1):49–54.

Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted billroth I gastrectomy. Surg Laparoscopy Endoscopy. 1994;4 (2):146–148. [12] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78 (5):606–617

Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg. 2009;144 (10):961–969.)

Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced recovery after surgery (ERAS(®)) society recommendations. Clin Nutr. 2013;32 (6):879–887

Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: enhanced recovery after surgery (ERAS) society recommendations-2019 update. Int J Gynecol Cancer. 2019;29 (4):651–668

Song W, Wang K, Zhang RJ, et al. The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. SpringerPlus. 2016;5 (1):207.

Grasu RM, Cata JP, Dang AQ, et al. Implementation of an enhanced recovery after spine surgery program at a large cancer center: a preliminary analysis[J]. J Neurosurg Spine. 2018;29 (5):588–598.

Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy. Br J Surg. 2014;101 (10):1209–1229.

Yao Y, Yao YC. Meta-analysis of accelerating rehabilitation surgery in laparoscopically assisted radical gastrectomy for distal gastric cancer. Journal of Modern Medicine and Health. 2019;35 (1):43–47. +51.

Cao S, Zheng T, Wang H, et al. Enhanced recovery after surgery in elderly gastric cancer patients undergoing laparoscopic total gastrectomy. J Surg Res. 2021;257:579–586.

Li Z, Wang Q, Li B, et al. Influence of enhanced recovery after surgery programs on laparoscopy-assisted gastrectomy for gastric cancer: a systematic review and meta-analysis of randomized control trials. World J Surg Oncol. 2017;15 (1):207.

Li M Z, Wu W h, Li L, et al. Is ERAS effective and safe in laparoscopic gastrectomy for gastric carcinoma? A meta-analysis. World J Surg Oncol. 2018;16 (1):17.

Zhang MK, Peng ZH, Huang H, et al. Meta-analysis of the role of enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer. Journal of Laparoscopic Surgery. 2021;26 (8):567–575.

Gu Y, Chen G, Zhang Y, et al. The relationship among the location, age, and clinicopathologic features of gastric cancer patients[J]. Progress in Modern Biomedicine. 2019;19 (16):3119–3123.

Liu K, Yang K, Zhang W, et al. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012: a single-institution, high-volume experience in China. Ann Surg. 2016;263 (1):88–95.

Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. 2019;10 (10): ED000142.

McGrath S, Zhao X, Steele R, et al. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res. 2020;29 (9):2520–2537.

Friedrich JO, Adhikari NKJ, Beyene J. Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available data. BMC Med Res Methodol. 2007;7 (1):5.

Furuya-Kanamori L, Barendregt JJ, Doi SAR. A new, improved graphical and quantitative method for detecting bias in meta-analysis. Int J Evid Based Health. 2018;16 (4):195–203.

Chen Hu J, Xin Jiang L, Cai L, et al. Preliminary experience of Fast-Track surgery combined with Laparoscopy-Assisted radical distal gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16 (10):1830–1839.

Kim JW, Kim WS, Cheong JH, et al. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg. 2012;36 (12):2879–2887.

Zhang ZB. Clinical study of fast-track surgery combined with laparoscopic resection for distal gastric cancer. Qingdao University, 2013.

Zhu CL, Fu T, Cai X. Fast-track surgery could improve postoperative recovery in radical distal gastrectomy patients. Journal of Modern Oncology. 2016;24 (12):1926–1930.

Ren K. Application of rapid rehabilitation concept in abdominal cavity distal radical gastric cancer. Journal of Medical Forum. 2017;38 (7):65–66. +69.

Xu X. Evaluation of the effect of Enhanced recovery after surgery (ERAS) on laparoscopy-assisted distal gastrectomy. Shanxi Medical University,2017.

Downloads

Published

2024-09-21

How to Cite

Hussein, D. H. F., Ali Al Hilli, D. L. A. M., & Kadhem, D. A. M. (2024). Assessment of the Effectiveness of Enhanced Recovery after Surgery (ERAS) Programs for Gastrectomy Iraqi Patients. International Journal of Alternative and Contemporary Therapy, 2(9), 78–85. Retrieved from http://medicaljournals.eu/index.php/IJACT/article/view/957