J Gastric Cancer.  2013 Jun;13(2):98-105.

Outcomes of Critical Pathway in Laparoscopic and Open Surgical Treatments for Gastric Cancer Patients: Patients Selection for Fast-Track Program through Retrospective Analysis

• Choi JW
• Xuan Y
• Hur H
• Byun CS
• Han SU
• Cho YK

Abstract

PURPOSE
The aim of this study is to investigate the clinical factors affecting on the cure rate by invasive and open surgery for gastric cancer and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis.
MATERIALS AND METHODS
In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery between January 2011 and December 2011 and were managed with conventional clinical therapies. This clinical algorithm was made when the patient was in minimally invasive surgery group and discharged from hospital one day faster than them in open surgery group.
RESULTS
The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than that of open group (P<0.001). In multivariate analysis, the surgical procedure of minimally invasive surgery (odds ratio=4.281) was the most predictable factor to complete clinical pathway. Additionally, younger patients (odds ratio=1.933) who underwent distal gastrectomy (odds ratio=1.999) without combined resection (odds ratio=3.069) were predicted to accomplish the clinical pathway without any modifications.
CONCLUSIONS
We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (expected completion rate=85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.

Keyword

Stomach neoplasms; Critical pathways; Gastrectomy; Minimally invasive

MeSH Terms

Critical Pathways
Gastrectomy
Humans
Multivariate Analysis
Retrospective Studies
Stomach Neoplasms

Figure

• 

  Fig. 1 Outcomes of patients selected by novel criteria for early recovery program in gastric cancer surgery.

Reference

1. Shin A, Kim J, Park S. Gastric cancer epidemiology in Korea. J Gastric Cancer. 2011; 11:135–140.

2. Kim JP. Current status of surgical treatment of gastric cancer. J Surg Oncol. 2002; 79:79–80.

3. Bradshaw BG, Liu SS, Thirlby RC. Standardized perioperative care protocols and reduced length of stay after colon surgery. J Am Coll Surg. 1998; 186:501–506.

4. Kulkarni RP, Ituarte PH, Gunderson D, Yeh MW. Clinical pathways improve hospital resource use in endocrine surgery. J Am Coll Surg. 2011; 212:35–41.

5. Lin YK, Chen CP, Tsai WC, Chiao YC, Lin BY. Cost-effectiveness of clinical pathway in coronary artery bypass surgery. J Med Syst. 2011; 35:203–213.

6. Uchiyama K, Takifuji K, Tani M, Onishi H, Yamaue H. Effectiveness of the clinical pathway to decrease length of stay and cost for laparoscopic surgery. Surg Endosc. 2002; 16:1594–1597.

7. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc. 2005; 19:1172–1176.

8. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008; 248:721–727.

9. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopyassisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002; 131:S306–S311.

10. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005; 19:168–173.

11. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.

12. Dy SM, Garg P, Nyberg D, Dawson PB, Pronovost PJ, Morlock L, et al. Critical pathway effectiveness: assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis. Health Serv Res. 2005; 40:499–516.

13. Pritts TA, Nussbaum MS, Flesch LV, Fegelman EJ, Parikh AA, Fischer JE. Implementation of a clinical pathway decreases length of stay and cost for bowel resection. Ann Surg. 1999; 230:728–733.

14. Jeong SH, Yoo MW, Yoon HM, Lee HJ, Ahn HS, Cho JJ, et al. Is the critical pathway effective for the treatment of gastric cancer? J Korean Surg Soc. 2011; 81:96–103.

15. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005; 92:1099–1102.

16. Persiani R, Antonacci V, Biondi A, Rausei S, La Greca A, Zoccali M, et al. Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg. 2008; 207:13–19.

17. Wu CW, Hsieh MC, Lo SS, Wang LS, Hsu WH, Lui WY, et al. Morbidity and mortality after radical gastrectomy for patients with carcinoma of the stomach. J Am Coll Surg. 1995; 181:26–32.

18. Hur H, Xuan Y, Ahn CW, Cho YK, Han SU. Trends and outcomes of minimally invasive surgery for gastric cancer: 750 consecutive cases in seven years at a single center. Am J Surg. 2013; 205:45–51.

19. Yasunaga H, Horiguchi H, Kuwabara K, Matsuda S, Fushimi K, Hashimoto H, et al. Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer: a propensity-matched analysis. Ann Surg. 2013; 257:640–646.

20. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006; 202:874–880.

21. Katai H, Sasako M, Sano T, Fukagawa T. Gastric cancer surgery in the elderly without operative mortality. Surg Oncol. 2004; 13:235–238.

22. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, et al. Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients. Am J Surg. 2006; 191:216–224.

23. Winslet MC, Mohsen YM, Powell J, Allum WH, Fielding JW. The influence of age on the surgical management of carcinoma of the stomach. Eur J Surg Oncol. 1996; 22:220–224.

24. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Crose N, et al. The Italian Gastrointestinal Tumor Study Group. Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. Ann Surg. 1997; 226:613–620.

25. Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, Maluenda F. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery. 2002; 131:401–407.

26. Otsuji E, Yamaguchi T, Sawai K, Okamoto K, Takahashi T. Total gastrectomy with simultaneous pancreaticosplenectomy or splenectomy in patients with advanced gastric carcinoma. Br J Cancer. 1999; 79:1789–1793.

27. Hur H, Kim SG, Shim JH, Song KY, Kim W, Park CH, et al. Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial. Surgery. 2011; 149:561–568.

28. Kim JW, Kim WS, Cheong JH, Hyung WJ, Choi SH, Noh SH. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg. 2012; 36:2879–2887.

29. Wang D, Kong Y, Zhong B, Zhou X, Zhou Y. Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg. 2010; 14:620–627.