Objective: To compare postoperative short-term outcomes and long-term prognosis between perioperative Enhanced Recovery After Surgery (ERAS) and conventional pathways protocols in gastric cancer patients. Methods: This is a single institute retrospective cohort study, all patients were pathologically proved to be gastric adenocarcinoma, underwent standard radical gastrectomy with D2 lymphadenectomy during the period of 2007-2012. Total 2124 cases were eligible to be analysed and divided into ERAS groups and Non-ERAS group according to the different perioperative pathway protocol. Propensity score matching method (in SPSS, 24.0 version, IBM Company) was used to balance the baseline characteristics. Two groups were matched in a 1∶1 ratio. There were 521 cases per group after matched. The short-term clinical outcomes (postoperative complications, length of hospital stay, blood loss, 30-day re-admission rate, etc.) and overall 5-year survival rates were compared between the two groups. Results: The incidence of overall postoperative complications was similar between the two groups (ERAS group=18.4%, non-ERAS group=19.4%, P=0.69), including anastomotic leakage, abdominal hemorrhage, etc. But the incidence of SSI, atelectasis, and thromboembolic disease in ERAS group was significant lower than that in Non-ERAS group. The number of lymph node harvested, operation time, intraoperative blood loss, postoperative hospital and cost in ERAS group were better than those in non-ERAS group. There were no significant differences in unplanned reoperation (ERAS group=3.1%, non-ERAS group=2.1%, P=0.33), 30 day readmission rate of discharge (ERAS group=6.1%, non-ERAS group=5.6%, P=0.69) and postoperative mortality (ERAS group=0.4%, non-ERAS group=0.2%, P=0.56) between the two groups. The 5-year overall survival rates of non-ERAS group and ERAS group were 66.2% and 72.8% respectively (P=0.007). The subgroup analysis found that 5-year OS rates of stage I were 93.4% and 92.7% (P=0.73), these of stage Ⅱ and Ⅲ were 82.2% vs 75.2% (P=0.007) and 47.6% vs 35.7% (P=0.02) in ERAS group and non-ERAS group respectively. Conclusions: Perioperative ERAS pathway management is safe and feasible for patients with gastric cancer, without increasing the incidence of complications and 30-day readmission rate. This protocol can improve the prognosis of patients with gastric cancer.
目的： 比较加速康复外科（ERAS）方案和传统围术期处理方案对胃癌患者术后近期临床结局和远期预后的影响。 方法： 本研究为回顾性队列研究，研究对象为2007—2012年间行标准胃癌根治术（D2淋巴结清扫术）的患者2 124例。根据围术期处理方案的不同分为ERAS组和非ERAS组（传统方案组）。针对两组患者基本临床特征的差异，采用倾向性得分匹配（PSM）的方法，匹配按照1∶1比例进行，每组得到521例。比较两组患者术后的并发症发生率、住院时间、出血量、30 d再入院率等及5年生存率。 结果： 两组术后总并发症发生率相似（ERAS组=18.4%，非ERAS组=19.4%，P=0.69），吻合口瘘、腹腔出血等并发症的发生率类似，无统计学差异。手术部位感染（SSI）、肺不张、血栓栓塞性疾病的发生率，ERAS组低于非ERAS组，差异有统计学意义。ERAS组的淋巴结清扫数目、手术时间、术中出血量、住院天数及费用都优于非ERAS组。两组患者的非计划再手术、30 d再入院率及围术期死亡率未见明显差异。非ERAS组和ERAS组的5年总生存率分别为66.2%和72.8%（P=0.007），Ⅰ期胃癌患者，ERAS组和非ERAS组的5年生存率分别为93.4%和92.7%（P=0.73），Ⅱ、Ⅲ期胃癌患者，ERAS组和非ERAS组5年生存率分别为82.2%和75.2%（P=0.007）、47.6%和35.7%（P=0.02），差异有统计学意义。 结论： 胃癌患者应用围手术期ERAS路径管理方案安全、可行，不增加并发症的发生率及30 d再入院率，同时可以改善胃癌患者的预后。.
Keywords: Clinical outcom; Enhanced Recovery After Surgery; Prognosis; Stomach, neoplasm.