Abstract / Summary
Prospective evaluations of adherence to enhanced recovery after surgery (ERAS) pathways for gastrectomy in diverse U.S. populations are limited. We conducted a prospective trial evaluating predefined ERAS pathways for patients undergoing distal subtotal (DG) and total gastrectomies (TG) with prophylactic or curative intent. Eight ERAS elements were selected: (1) pre-operative discussion about recovery milestones, (2) MIS preference, (3) avoidance of NGTs, (4) post-operative IV NSAIDs and/or IV acetaminophen, (5) early foley removal, (6) early mobilization, (7) early diet advancement, and (8) post-operative discharge day (POD). Primary endpoint was discharge by POD5 for DG and POD6 for TG. Secondary endpoints included patient-reported QoL and pathway deviation reasons. Demographics, adherence to ERAS components, peri-operative outcomes, and QoL surveys were evaluated. 51/78 GC patients were enrolled, who received pre-operative counseling on ERAS components and received either DG (41%) or TG (59%) with a robotic (80%) or open (20%) approach. Median LOS was 4.5 days for DG and 5.4 days for TG. 18/21 (86%) DG patients discharged ≥ 24 h of target discharge date adhered to ERAS elements compared to 22/31 (71%) TG patients. All patients were discharged directly home. Patients with complications 12/51 (24%) had significantly lower adherence to ERAS elements, with 81% experiencing delays in discharge ( P < 0.001). Global QoL was preserved 6 months after gastrectomy; sub-categories, including physical functioning, fatigue, and pain initially declined but recovered 6 months post-operatively. In this prospective study of an ethnically diverse U.S. population, delivery of a standardized gastrectomy ERAS pathway was feasible, achieved high adherence to procedure-specific discharge targets, and preserved global QoL. These findings support prospective multicenter validation of complete ERAS programs. The trial was registered at ClinicalTrials.gov (NCT03997162) on 2018-08-06.