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Early Return to Intended Oncologic Therapy after implementation of an Enhanced Recovery After Surgery pathway for gastric cancer surgery

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Abstract

Purpose

Time to initiation and completion of adjuvant therapy are critical to improve postoperative oncologic outcomes. This study aims to determine whether an Enhanced Recovery After Surgery (ERAS) pathway for gastric cancer surgery promotes early Return to Intended Oncologic Therapy (RIOT).

Methods

This is a before-after intervention study including patients with gastric adenocarcinoma who underwent surgery from January 2016 to January 2021. Two periods were denoted based upon the implementation date of our institutional ERAS pathway (June 2018). Our primary outcome was time to RIOT after surgery. Hodges-Lehmann analysis was used to estimate median differences of non-parametric outcomes.

Results

Seventy patients with gastric adenocarcinoma were included (35 in pre-ERAS period and 35 in post-ERAS period). Fourteen of the pre-ERAS and twenty-two patients of the post-ERAS period received adjuvant therapy. Time to RIOT was reduced in the post-ERAS period (median 39 days, IQR 31–49) by 12 days (95% CI 3–14 days, p = 0.01) compared to the pre-ERAS period (median 51 days, IQR 42–62). Length of hospital stay (LOS) was lower in the ERAS group (6 days, IQR 5–11 vs 10 days, IQR 8–13, p < 0.01).

Conclusion

Our institutional ERAS pathway for gastric cancer surgery was associated with earlier RIOT and shorter LOS.

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Acknowledgements

The authors thank Grupo Español De Rehabilitación Multimodal (GERM) for their role in designing, implementing, monitoring, and improving the ERAS pathways for patients with gastric cancer. GERM had no role in the analysis and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Funding

Support was only provided by institutional sources.

Author information

Authors and Affiliations

  1. Department of Surgery, Infanta Leonor University Hospital, Madrid, Spain

    Maria Garcia-Nebreda, Edurne Alvaro Cifuentes & Gloria Paseiro-Crespo

  2. Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain

    Maria Garcia-Nebreda, Javier Ripollés-Melchor, Ane Abad-Motos, Alfredo Abad-Gurumeta & Gloria Paseiro-Crespo

  3. Universidad Complutense de Madrid, Madrid, Spain

    Maria Garcia-Nebreda, Javier Ripollés-Melchor, Ane Abad-Motos, Edurne Alvaro Cifuentes, Alfredo Abad-Gurumeta & Gloria Paseiro-Crespo

  4. Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Andrés Zorrilla-Vaca & Gabriel E. Mena

  5. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Andrés Zorrilla-Vaca

  6. Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain

    Javier Ripollés-Melchor, Ane Abad-Motos & Alfredo Abad-Gurumeta

  7. Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain

    Javier Ripollés-Melchor & Alfredo Abad-Gurumeta

  8. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA

    Michael C. Grant

Authors
  1. Maria Garcia-Nebreda
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  2. Andrés Zorrilla-Vaca
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  3. Javier Ripollés-Melchor
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  6. Alfredo Abad-Gurumeta
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  7. Gabriel E. Mena
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  8. Michael C. Grant
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  9. Gloria Paseiro-Crespo
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Contributions

Maria Garcia-Nebreda: study conception and design, acquisition of data, analysis and interpretation of data, critical revision of manuscript. Andrés Zorrilla-Vaca: analysis and interpretation of data; drafting of manuscript; critical revision of manuscript. Javier Ripollés-Melchor: study conception and design, drafting of manuscript, critical revision of manuscript. Ane Abad-Motos: critical revision of manuscript. Edurne Alvaro Cifuentes: acquisition of data, critical revision of manuscript. Alfredo Abad-Gurumeta: critical revision of manuscript. Gabriel E. Mena: analysis and interpretation of data; drafting of manuscript; critical revision of manuscript. Michael C. Grant: analysis and interpretation of data; drafting of manuscript; critical revision of manuscript. Gloria Paseiro-Crespo: study conception and design, acquisition of data, analysis and interpretation of data, critical revision of manuscript.

Corresponding author

Correspondence to Maria Garcia-Nebreda.

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Conflict of interest

Dr. Ripollés-Melchor reports personal fees from Edwards Lifesciences and Vifor Pharma outside the submitted work. Dr. Abad-Gurumeta reports personal fees from Edwards Lifesciences, MSD, and 3 M outside the submitted work. Ane Abad-Motos reports support for attending meetings and/or travel from Edwards Lifesciences outside the submitted work. Maria Garcia-Nebreda, Andrés Zorrilla-Vaca, Edurne Alvaro Cifuentes, Gabriel E. Mena, Michael C. Grant, and Gloria Paseiro-Crespo have nothing to declare.

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Garcia-Nebreda, M., Zorrilla-Vaca, A., Ripollés-Melchor, J. et al. Early Return to Intended Oncologic Therapy after implementation of an Enhanced Recovery After Surgery pathway for gastric cancer surgery. Langenbecks Arch Surg 407, 2293–2300 (2022). https://doi.org/10.1007/s00423-022-02515-7

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  • DOI: https://doi.org/10.1007/s00423-022-02515-7

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