EARLY OUTCOMES OF LAPAROSCOPIC GASTRECTOMY FOR GASTRIC CANCER UNDER AN ERAS PROGRAM
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Abstract
Background: Laparoscopic gastrectomy combined with Enhanced Recovery After Surgery (ERAS) pathways may improve postoperative recovery in gastric cancer surgery; however, real‑world data from Vietnam remain limited.
Objectives: To describe perioperative characteristics and evaluate early outcomes after laparoscopic D2 gastrectomy under an ERAS program, and to assess the association between ERAS compliance and recovery metrics.
Methods: A retrospective descriptive-analytical study of 54 consecutive gastric cancer patients undergoing curative laparoscopic gastrectomy with D2 lymphadenectomy (01/2024–12/2025) at Cho Ray Hospital and a satellite center. ERAS adherence was quantified using a 25‑item score (ERAS_adj_25, 0–25) and categorized as low (<16), intermediate (16–18), or high (≥19). Primary outcomes were time to first flatus, time to liquid diet, and postoperative length of stay (LOS). Secondary outcomes included pain scores (VAS at 6/24/48 hours), opioid use within 48 hours, and 30‑day morbidity, readmission, and mortality.
Results: Mean age was 62.3±11.3 years; 64.8% were male; 94.5% were ASA I–II. Tumor location: antrum 34 (63.0%), lesser curvature angle 6 (11.1%), body 10 (18.5%), and cardia 4 (7.4%). Most patients had locally advanced disease (T3–T4: 92.6%; stage III: 66.7%). Distal gastrectomy accounted for 74.1% and total gastrectomy for 24.1%, proximal subtotal gastrectomy 1.9%. No routine abdominal drainage was applied in 38.9%. Mean time to flatus was 2.44±0.57 days, time to liquid diet 2.54±0.50 days, and LOS 5.15±1.20 days. Pain scores decreased over time (VAS 6h 2.72±0.45; 24h 2.69±0.47; 48h 1.89±0.39) with minimal opioid requirement. LOS was significantly shorter in the no‑drain group (4.6±0.8 vs 5.5±1.2 days; p=0.003). Higher ERAS_adj_25 scores correlated with faster recovery and shorter LOS. Superficial Pfannenstiel wound infection occurred in 12.9% (CDC superficial incisional SSI; Clavien–Dindo I–II); no anastomotic leak, reoperation, 30‑day mortality, or readmission was observed.
Conclusions: Laparoscopic D2 gastrectomy within an ERAS program is feasible and safe in tertiary and satellite settings, yielding favorable early recovery with low major morbidity. Higher ERAS compliance is associated with improved recovery.
Keywords
gastric cancer, laparoscopic gastrectomy, D2 lymphadenectomy, ERAS, early recovery
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References
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