Gastric Cancer

, Volume 22, Issue 3, pp 423–434 | Cite as

Enhanced recovery versus conventional care in gastric cancer surgery: a meta-analysis of randomized and non-randomized controlled trials

  • Ian Jun Yan Wee
  • Nicholas Li-Xun Syn
  • Asim Shabbir
  • Guowei Kim
  • Jimmy B. Y. SoEmail author
Review Article



Enhanced recovery after surgery (ERAS) protocols have been successfully integrated into peri-operative management of different cancer surgeries such as colorectal cancer. Their value for gastric cancer surgery, however, remains uncertain.


A search for randomized and observational studies comparing ERAS versus conventional care in gastric cancer surgery was performed according to PRISMA guidelines. Random-effects meta-analyses with inverse variance weighting were conducted, and quality of included studies was assessed using the Cochrane risk-of-bias tool and Newcastle-Ottawa scale (PROSPERO: CRD42017080888).


Twenty-three studies involving 2686 patients were included. ERAS was associated with reduced length of hospital stay (WMD—2.47 days, 95% CI − 3.06 to − 1.89, P < 0.00001), time to flatus (WMD—0.70 days, 95% CI − 1.02 to − 0.37, P < 0.0001), and hospitalization costs (WMD—USD$ 4400, 95% CI − USD$ 5580 to − USD$ 3210, P < 0.00001), with consistent results across open and laparoscopic surgery. Postoperative morbidity and 30-day mortality were similar, although a higher rate of readmission was observed in the ERAS group (RR = 1.95, 95% CI 1.03–3.67, P = 0.04). Patients in the ERAS arm had significantly attenuated C-reactive protein levels on days 3/4 and 7, interleukin-6 levels on days 1, and 3/4, and tumor necrosis factor-α levels on days 3/4 postoperatively.


Compared to conventional care, ERAS reduces hospital stay, costs, surgical stress response and time to return of gut function, without increasing post-operative morbidity in gastric cancer surgery. However, precaution is necessary to reduce the increased risk of hospital readmission when adopting ERAS.


ERAS Enhanced recovery after surgery Gastric surgery Gastric cancer 



NLS and IW are supported by Wong Hock Boon Society funds from the Yong Loo Lin School of Medicine, National University of Singapore.

Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interest.

Supplementary material

10120_2019_937_MOESM1_ESM.docx (121 kb)
Supplementary material 1 (DOCX 120 KB)
10120_2019_937_MOESM2_ESM.docx (3 mb)
Supplementary material 2 (DOCX 3029 KB)


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  • Ian Jun Yan Wee
    • 1
    • 2
  • Nicholas Li-Xun Syn
    • 2
    • 3
  • Asim Shabbir
    • 2
    • 3
  • Guowei Kim
    • 2
  • Jimmy B. Y. So
    • 2
    • 3
    Email author
  1. 1.Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  2. 2.Division of General SurgeryUniversity Surgical Cluster, National University HospitalSingaporeSingapore
  3. 3.Department of Surgery, Yong Loo Lin School of MedicineNational University of Singapore, National University Health SystemSingaporeSingapore

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