Arginaid drug classification

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* Corresponding aut

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http://dx.doi.org/10.10

0748-7983/� 2016 El

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EJSO 43 (2017) 210e217 www.ejso.com

Enhanced recovery after surgery for gastric cancer and an assessment of preoperative carbohydrate loading

R. Makuuchi a, N. Sugisawa b, S. Kaji a, M. Hikage a, M. Tokunaga a, Y. Tanizawa a, E. Bando a, T. Kawamura a, M. Terashima a,*

aDivision of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-Cho, Sunto-Gun,

Shizuoka, 411-8777, Japan bDepartment of Surgery, Tohoku University Graduate School of Medicine, 2-1, Seiryo-Machi, Aoba-Ku,

Sendai-Shi, Miyagi, 980-8575, Japan

Accepted 25 July 2016

Available online 10 August 2016

Abstract

Background: We previously reported on the feasibility of enhanced recovery after surgery (ERAS) protocol for gastric cancer with a pro- spective phase II study, but the superiority of this approach over non-ERAS perioperative management remains unclear. Preoperative car- bohydrate loading, an important element of the ERAS protocol, has been shown to reduce insulin resistance, but its effects on clinical endpoints in gastric cancer surgery remain controversial. The aim of this study was to clarify the efficacy of the ERAS protocol for gastric cancer surgery, with particular focus on preoperative carbohydrate loading. Methods: In this ERAS caseecontrol study, we enrolled 121 patients as a case group and 259 patients undergoing gastrectomy for gastric cancer with our conventional perioperative management as a control group. Matched-pair analysis was performed to balance the patients’ characteristics for comparison analysis. Results: After matching, 108 patients were included in each group. Postoperative hospital stay was significantly shorter in the ERAS group than in the control group (8 days vs. 9 days, p < 0.001), while the incidence of ClavieneDindo classification grade II or more postoperative complication was similar between the groups (11.1% vs. 15.7%, p ¼ 0.325). No significant differences were found in serum albumin level, body weight, or grip strength between the groups before surgery and at 1 week and 1 month after surgery. Conclusion: Use of the ERAS protocol for gastric cancer shortened the length of postoperative hospital stay without increasing complica- tions. Preoperative carbohydrate loading didn’t improve the postoperative nutritional status or maintain the muscle strength postoperatively. � 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Keywords: Stomach neoplasms; Gastrectomy; Perioperative care; Carbohydrates; Case-control study

Introduction

The enhanced recovery after surgery (ERAS) protocol, also known as fast track surgery, involves integrated appli- cation of various medical interventions to accelerate recov- ery after surgery. It has been shown to shorten postoperative hospital stay and reduce postoperative complication in various surgeries, particularly colorectal surgery.1e5