J Korean Gastric Cancer Assoc.  2009 Mar;9(1):18-25.

Is a Fast-track Critical Pathway Possible in Gastric Cancer Surgery?

Affiliations
  • 1Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea. hmjeon@catholic.ac.kr

Abstract

PURPOSE
The postoperative hospital stay after gastric cancer surgery is usually 8 to 14 days. The main reason for a prolonged hospital stay may be the 3 to 4 day period of postoperative starvation. The aim of this study is to investigate the feasibility of a critical pathway for early recovery after gastric cancer surgery, and this pathway included early postoperative feeding.
MATERIALS AND METHODS
One hundred three consecutive patients who underwent gastric resection and reconstruction for gastric cancer from October 2007 to June 2008 at St. Mary's Hospital were prospectively enrolled in a fast-track critical pathway. The pathway included minimal preoperative procedures, optimal pain relief, proper fluid administration, early mobilization and early enteral nutrition at postoperative 1 day. The exclusion criteria were determined preoperatively, intraoperatively and postoperatively.
RESULTS
Of the 103 patients, 19 patients were excluded for preoperative (5), intraoperative (7) and postoperative (7) reasons. Eighty-four patients (81.6%) were included in the fast-track critical pathway. Sixty-eight (88.6%) of 84 patients were discharged at the planned 8 day after surgery during the initial period of the study, and the postoperative hospital stay was shortened up to 6 days during the more recent period. Postoperative complications occurred in 22 patients (26.2%), and these were gastrointestinal track-related complications in 6 cases (3 cases of ileus, 1 case of stasis and 2 cases of leakage) and infection-related complications in 8 cases. There was no statistical difference in the incidence of morbidity according to the clinic-operative features that included age, gender, stomach resection and lymphadenectomy.
CONCLUSION
The fast-track critical pathway with using the available exclusion criteria was a valid option for patients who underwent gastric cancer surgery.

Keyword

Stomach cancer; Early recovery after surgery; Critical pathway

MeSH Terms

Critical Pathways
Early Ambulation
Enteral Nutrition
Humans
Ileus
Incidence
Length of Stay
Postoperative Complications
Preoperative Care
Prospective Studies
Starvation
Stomach
Stomach Neoplasms
Full Text Links
  • JKGCA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr