Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1334-1343
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1334
Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?
Zi-Wei Li, Xiao-Juan Luo, Fei Liu, Xu-Rui Liu, Xin-Peng Shu, Yue Tong, Quan Lv, Xiao-Yu Liu, Wei Zhang, Dong Peng
Zi-Wei Li, Fei Liu, Xu-Rui Liu, Xin-Peng Shu, Yue Tong, Quan Lv, Xiao-Yu Liu, Wei Zhang, Dong Peng, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Xiao-Juan Luo, Department of Endoscopy Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400012, China
Co-first authors: Zi-Wei Li and Xiao-Juan Luo.
Author contributions: Zi-Wei Li and Xiao-Juan Luo have contributed equally to this work. Data extraction, Xiao-Yu Liu, Xiao-Juan Luo, Xin-Peng Shu, Yue Tong, Quan Lv, and Fei Liu; quality assessments, Xu-Rui Liu and Wei Zhang; data analysis, Zi-Wei Li and Quan Lv; writing-origin draft, Zi-Wei Li; writing-review and editing, Zi-Wei Li, Dong Peng. All authors read and approved the final manuscript. Li ZW and Luo XJ contributed equally to this work as co-first authors. The choice of these researchers as co-first authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Li ZW and Luo XJ as co-first authors of is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by Chongqing Medical University Program for Youth Innovation in Future Medicine, No. W0190.
Institutional review board statement: The data used in this study were obtained from public databases. No Institutional Review board Approval were needed.
Informed consent statement: The data was accessed in the database and all patients signed informed consent.
Conflict-of-interest statement: The authors declare that there are no conflicts of interests.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Peng, PhD, Adjunct Associate Professor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China. carry_dong@126.com
Received: December 18, 2023
Peer-review started: December 18, 2023
First decision: January 4, 2024
Revised: January 15, 2024
Accepted: February 20, 2024
Article in press: February 20, 2024
Published online: April 15, 2024
ARTICLE HIGHLIGHTS
Research background

This study aimed to evaluate the safety of enhanced recovery after surgery (ERAS) in elderly patients with gastric cancer (GC).

Research motivation

Elderly patients usually have a poor physiological function, more comorbidities, and slow recovery after surgery. Although the application of ERAS protocol in elderly patients with GC has been reported. For elderly patients with GC, there is no convincing evidence that the ERAS protocol is a safe and effective measure.

Research objectives

It was necessary for us to find out whether ERAS could be safely implemented in elderly patients.

Research methods

The PubMed, EMBASE, and Cochrane Library databases were used to search for eligible studies from inception to April 1, 2023. The mean difference (MD), odds ratio (OR) and 95% confidence interval (95%CI) were pooled for analysis. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores. We used Stata (V.16.0) software for data analysis.

Research results

This study consists of six studies involving 878 elderly patients. By analyzing the clinical outcomes, we found that the ERAS group had shorter postoperative hospital stays (MD = -0.51, I2 = 0.00%, 95%CI = -0.72 to -0.30, P = 0.00); earlier times to first flatus(defecation; MD = -0.30, I2 = 0.00%, 95%CI = -0.55 to -0.06, P = 0.02); less intestinal obstruction (OR = 3.24, I2 = 0.00%, 95%CI = 1.07 to 9.78, P = 0.04); less nausea and vomiting (OR = 4.07, I2 = 0.00%, 95%CI = 1.29 to 12.84, P = 0.02); and less gastric retention (OR = 5.69, I2 = 2.46%, 95%CI = 2.00 to 16.20, P = 0.00). Our results showed the conventional group had a greater mortality rate than the ERAS group. (OR = 0.24, I2 = 0.00%, 95%CI = 0.07 to 0.84, P = 0.03). However, there was no statistically significant difference in the major complications between the ERAS group and the conventional group (OR = 0.67, I2 = 0.00%, 95%CI = 0.38 to 1.18, P = 0.16).

Research conclusions

Compared to those with conventional recovery, elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.

Research perspectives

Compared to those with conventional recovery, elderly GC patients who received the ERAS protocol after surgery was associated with a lower risk of mortality. ERAS protocol was safe in elderly patients with GC.