The findings from this investigation revealed noteworthy distinctions in various postoperative parameters between the ERAS group and the traditional group. Specifically, postoperative ambulation time, the time to first flatus, hospital stay, and postoperative feeding time were significantly reduced in the ERAS group compared to the traditional group, attaining statistical significance. These results indicate that the adoption of ERAS represents a feasible, safe, and effective therapeutic strategy for gastric cancer. Additionally, although the difference did not achieve statistical significance, it is worth mentioning that the hospitalization expenses in the ERAS group exhibited a notable reduction in comparison to the conventional group[8, 14, 15]. This study also reached a similar conclusion.
The integration of ERAS has markedly reduced postoperative duration of enteral feeding, bed rest, anal exhaust, and overall hospitalization days. Moreover, a substantial decrease in the overall costs associated with hospitalization has been observed. The lack of a statistically significant difference in the frequency of postoperative complications between the conventional group and the ERAS group aligns with the findings of the present study[14]. Broadly speaking, it can be deduced that the application of ERAS does not yield a general escalation in the frequency of postoperative complications[16]. Within this context, the implementation of ERAS can be considered both feasible and safe.
In light of the preceding discussion, it can be deduced that the ERAS program affords a notable improvement in the immediate clinical outcomes of individuals undergoing surgery for gastric cancer. The considerable effectiveness noted in the immediate term can be attributed to the synergistic impact of pre-rehabilitation interventions[17–19], multimodal analgesia, preoperative education[20–23], intraoperative heat preservation[24–26], GDFT(Goal-directed fluid therapy)[7, 27, 28] and stress reduction in ERAS.
Presently, investigations examining the association between ERAS and the prolonged survival of patients with gastric cancer remain constrained. Given that the ERAS concept has a relatively recent history of approximately 20 years, it represents a nascent field. Therefore, additional investigations are warranted to explore the extended clinical repercussions and survival benefits conferred by ERAS in the context of gastric cancer.
The findings of this study disclosed a substantial enhancement in the 5-year overall survival rate in patients undergoing gastric cancer surgery with the incorporation of ERAS compared to the conventional group, reaching statistical significance. Although subgroup analysis did not reveal a significant difference, it suggested a heightened 5-year survival rate in the ERAS group for patients in pTNM stage III in comparison to the traditional group. However, no significant differences in the 5-year survival rate were observed between the ERAS and traditional groups for patients in pTNM stages I and II. This observation suggests a potential benefit of ERAS for individuals in pTNM stage III. The influence of ERAS following laparoscopic gastrectomy in contrast to conventional treatment on both immediate clinical outcomes and prolonged prognostic considerations[9]. The ERAS group demonstrated significantly abbreviated postoperative hospital stays (7.09 vs 8.67 days, P < 0.001) along with diminished durations for time to first flatus, fluid intake, and ambulation (2.50 vs 3.40 days, P < 0.001; 1.02 vs 3.64 days, P < 0.001; 1.47 vs 2.99 days, P = 0.009). Furthermore, the ERAS cohort experienced diminished healthcare expenditures (7621.75 vs. 7814.1 US dollars, P = 0.009), and a decreased occurrence of postoperative complications was noted in contrast to the standard care group (12.3% vs. 18.1%, P = 0.030). Inflammatory indicators, such as C-reactive protein (CRP) and procalcitonin levels, manifested notable distinctions between the two cohorts at the 3–4 days postoperative interval (P = 0.025).Notably, the ERAS regimen was linked to significantly enhanced 5-year overall survival (OS) and cancer-specific survival (CSS) in contrast to the conventional regimen (P = 0.013 and 0.032, respectively). Following stratification based on the pTNM stage, a noteworthy disparity in survival was evident exclusively among patients in stage III (P = 0.044), thereby indicating that ERAS contributes to enhanced short-term outcomes, 5-year overall survival, and cancer-specific survival subsequent to laparoscopic gastrectomy.
Drawing upon the previously mentioned studies, it is apparent that ERAS can significantly augment the 5-year survival rate in individuals diagnosed with gastric cancer. The present study elucidates a substantial disparity in the overall 5-year survival rates between the ERAS and conventional groups, consistent with the observations made by Tian[9].
Nevertheless, a minority of scholars has presented dissenting perspectives on the correlation between ERAS and long-term prognosis. It has been argued that ERAS fails to enhance the long-term quality of life for patients with bladder cancer[29]. Moreover, delineating a distinct correlation between ERAS and the prolonged overall survival rate in patients undergoing tumor surgery presents a substantial challenge[10]. The adoption of ERAS with a high compliance rate did not result in enhancements in the overall survival rate among patients diagnosed with non-metastatic advanced gastric cancer[11]. The disparate findings among the aforementioned studies may be attributed to variations in inclusion criteria, encompassing differences in diseases under consideration, sample sizes, and surgical methodologies.
The increasing adoption of ERAS is attributed to its capacity to promote the standardization of perioperative care and improve overall perioperative outcomes. Nevertheless, a thorough comprehension of the precise mechanisms underpinning the advantageous effects of ERAS on patients with gastric cancer necessitates further exploration.