Is a Fast-track Critical Pathway Possible in Gastric Cancer Surgery?.
10.5230/jkgca.2009.9.1.18
- Author:
Jeong Min YI
1
;
Hoon HUR
;
Sung Keun KIM
;
Kyo Young SONG
;
Hyung Min CHIN
;
Wook KIM
;
Cho Hyun PARK
;
Seung Man PARK
;
Keun Woo LIM
;
Hae Myung JEON
Author Information
1. Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea. hmjeon@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Stomach cancer;
Early recovery after surgery;
Critical pathway
- MeSH:
Critical Pathways;
Early Ambulation;
Enteral Nutrition;
Humans;
Ileus;
Incidence;
Length of Stay;
Postoperative Complications;
Preoperative Care;
Prospective Studies;
Starvation;
Stomach;
Stomach Neoplasms
- From:Journal of the Korean Gastric Cancer Association
2009;9(1):18-25
- CountryRepublic of Korea
- Language:Korean
-
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.
