ERAS Protocols for Gastrectomy

Abstract

The interest in the Enhanced Recovery After Surgery (ERAS) protocols on gastrectomy for cancer is fairly new and mainly comes from Eastern series. Gastrectomy is a major abdominal operation and is still burdened by a 30% overall morbidity and a 4.5% mortality. The ERAS protocol aims to optimize the patient’s condition and reduce surgical and anesthesiologic stress in order to reduce complications and secondarily reduce hospitalization. Two recent meta-analyses evidenced a reduction in length of hospital stay, bowel recovery and cost reduction, while also reporting, however, a higher risk for readmission in patients treated with an ERAS protocol. In this chapter we discuss the importance of implementing a multidisciplinary team focusing on gastrectomy-specific items starting from preoptimization up to discharge. Preoptimization should focus on inspiratory muscle training and optimization of the nutritional status, especially for patients undergoing neoadjuvant treatment. A minimally invasive approach can reduce surgical stress and should be considered in accordance with the current oncological guidelines. Anesthesia should focus on a goal-directed fluid approach and on a defined multimodal analgesia plan. The goal of the postoperative management is an early mobilization and resumption of oral intake through the avoidance of unnecessary tubes. Discharge should be based on defined criteria and the patient’s network.