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Enhanced Recovery After Surgery (ERAS) programs have been introduced with purposes of reducing the surgical stress response and obtaining optimal recovery after surgery.
There is strong evidence of the usefulness of the ERAS programs in patients undergoing colorectal surgery in terms of significantly reduced postoperative complications and shorter length of hospital stay, compared to the patients of conventional treatment.
However, few studies exist about the implication of ERAS programs in the laparoscopic gastrectomy.
The aim of this study was to compare the recovery rate, morbidity, and quality of life in the patients undergoing laparoscopic total gastrectomy and proximal gastrectomy for gastric cancer, receiving either ERAS protocol or conventional postoperative cares.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ERAS perioperative cares | Active Comparator | Patients planned to undergoing laparoscopic total gastrectomy, following the ERAS protocols |
|
| Conventional perioperative cares | Active Comparator | Patents will be managed by our hospital's critical pathways |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ERAS perioperative cares | Procedure | Patient's preoperative counseling & education before surgery No Bowel preparation Oral Carbohydrate Solution (OCS) loading until 2hours before surgery Fluid restriction & Management by pulse contour analysis or transesophageal doppler Early mobilization Early oral feeding (postoperative 1 day - sips of water, 2 days - semifluid diet (SFD), 3 days - soft blended diet (SBD)) Epidural patient controlled analgesics (no opioids analgesics) Postoperative Nausea Active Control Thromboembolism prophylaxis by low molecular weighted heparin (LMWH) Perioperative High content Oxygen therapy No drain insertion No Levin tube Patients will be discharged at POD#4 if there's no problem. |
| Measure | Description | Time Frame |
|---|---|---|
| Tolerance of diet for 24 hours | Tolerance of diet for 24 hours. Able to eat one third of more of soft-blend meal without abdominal discomfort, bloating, nausea, or vomiting | 4 days after surgery |
| Analgesic-free | Analgesic-free (oral or IV analgesic drugs not necessary after cessation of PCA) | 4 days after surgery |
| Safe ambulation | Safe ambulation (ambulation of 600m without assistance) | 4 days after surgery |
| Afebrile status without major complications | Afebrile status without major complications (fever defined as body temperature greater than 37.5) | 4 days after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative length of hospital stay | Postoperative length of hospital stay | up to 4 weeks after surgery |
| Time to tolerance of a full diet | Time to tolerance of a full diet |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Bundang Hospital | Recruiting | Seongnam-si | Gyeonggi-do | 463-707 | South Korea |
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| ID | Term |
|---|---|
| D013274 | Stomach Neoplasms |
| ID | Term |
|---|---|
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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|
| Conventional perioperative cares | Procedure | No Patient's preoperative counseling & education before surgery Bowel preparation No Oral Carbohydrate Solution (OCS) loading until 2hours before surgery Conventional Fluid Management by clinical signs (Urine output, heart rate etc.) Conventional Mobilization Conventional oral feeding (POD#2 SOW, #3 SFD, #4 SBD) IV PCA Postoperative Nausea Control if needed No Thromboembolism prophylaxis No or Low Content Oxygen therapy Routine drain insertion Levin tube insertion if needed |
|
| up to 1 month after surgery |
| Time to first bowel motion | Time to first bowel motion | up to 7 days after surgery |
| D004066 |
| Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D013272 | Stomach Diseases |