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Safety and Efficacy of Fast-track Surgery in Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Clinical Trial

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Abstract

Background

Fast-track surgery has been shown to enhance postoperative recovery in several surgical fields. This study aimed to evaluate the safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy.

Methods

The present study was designed as a single-center, randomized, unblinded, parallel-group trial. Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated. The fast-track surgery protocol included intensive preoperative education, a short duration of fasting, a preoperative carbohydrate load, early postoperative ambulation, early feeding, and sufficient pain control using local anesthetics perfused via a local anesthesia pump device, with limited use of opioids. The primary endpoint was the duration of possible and actual postoperative hospital stay.

Results

We randomized 47 patients into a fast-track group (n = 22) and a conventional pathway group (n = 22), with three patients withdrawn. The possible and actual postoperative hospital stays were shorter in the fast-track group than in the conventional group (4.68 ± 0.65 vs. 7.05 ± 0.65; P < 0.001 and 5.36 ± 1.46 vs. 7.95 ± 1.98; P < 0.001). The time to first flatus and pain intensity were not different between groups; however, a greater frequency of additional pain control was needed in the conventional group (3.64 ± 3.66 vs. 1.64 ± 1.33; P = 0.023). The fast-track group was superior to the conventional group in several factors of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, including: fatigue, appetite loss, financial problems, and anxiety. The complication and readmission rates were similar between groups.

Conclusions

Fast-track surgery could enhance postoperative recovery, improve immediate postoperative quality of life, and be safely applied in laparoscopic distal gastrectomy.

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Acknowledgments

The LAPD was supplied from B. Braun Korea Company just for this study. The drug which was loaded into the LAPD was paid for by the patients. The authors are grateful to Hyunsun Lim from Gangnam Severance Hospital Biomedical Research Center, Yonsei University College of Medicine, for valuable advice in the statistical analyses.

Conflict of interest

The authors do not have any conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea

    Jong Won Kim, Whan Sik Kim & Seung-Ho Choi

  2. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, 120-752, Korea

    Jae-Ho Cheong, Woo Jin Hyung & Sung Hoon Noh

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  1. Jong Won Kim
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  2. Whan Sik Kim
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Correspondence to Seung-Ho Choi.

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Kim, J.W., Kim, W.S., 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 36, 2879–2887 (2012). https://doi.org/10.1007/s00268-012-1741-7

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