ERAS pathway for gastric cancer surgery: adherence, outcomes and prognostic factors for compliance in a Western centre

Adherence to an ERAS program guarantees an evidence-based approach for patient care, but the compliance to ERAS in patients undergoing surgery for gastric cancer in Western countries has not been clearly investigated. Our Institution has implemented an ERAS pathway (EP) for gastric surgery, composed of 24 items, since December 2016. We retrospectively analyzed the data of all consecutive patients undergoing surgery with curative intent for gastric cancer between January 2017 and December 2019 at our Institution, and were eligible for our EP. The primary endpoint was patients' compliance to the EP. Secondary endpoints were patients' adherence to each ERAS item and detection of variables associated with compliance failure. Seventy-three patients were included. Among these, 75.3% completed the EP, with a median number of items accomplished per patient of 21. Items with critical adherence were restrictive intraoperative fluid infusion (37%), avoidance of abdominal drain (14%), first clear liquid intake (67%), first solid food intake (48%). At univariate analysis age > 75 years, ASA > 2 and total gastrectomy were associated with failure to complete the EP. At multivariate analysis, ASA Score > 2 was the only preoperative factor associated with EP failure. Application of an ERAS program for malignant gastric surgery seems to be feasible with an acceptable completion rate in a tertiary referral Western centre. Preoperative factors, such as old age, advanced stage at diagnosis and neoadjuvant chemotherapy should not be considered as exclusion criteria for ERAS.

Automated summary

This study aimed to investigate the compliance to an ERAS program for gastric cancer surgery in Western countries, with findings indicating that most patients were able to adhere to the ERAS pathway. However, critical items had lower adherence rates, and factors such as age, ASA score, and total gastrectomy were associated with failure to complete the ERAS pathway. Despite these challenges, the ERAS program showed feasibility in malignant gastric surgery at a tertiary referral Western center, suggesting that preoperative factors should not be exclusion criteria for ERAS.