Randomized Controlled Trial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2016; 8(5): 382-388
Published online May 27, 2016. doi: 10.4240/wjgs.v8.i5.382
Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy
Nobuaki Fujikuni, Kazuaki Tanabe, Noriaki Tokumoto, Takahisa Suzuki, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan
Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan
Noriaki Tokumoto, Department of Surgery, Hiroshima City Hospital, Hiroshima 730-8518, Japan
Takahisa Suzuki, Department of Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
Author contributions: Tanabe K, Tokumoto N, Suzuki T and Ohdan H concept and designed this study; Fujikuni N, Tanabe K, Tokumoto N, Suzuki T and Misumi T were the clinical investigators with more patients recruited and treated; Fujikuni N and Hattori M analyzed the data; Fujikuni N and Tanabe K drafted the manuscript and made the final approved the version to be published.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the study institution (Hiroshima University, Japan).
Clinical trial registration statement: This study is registered at UMIN Clinical Trials Registry. The registration identification number is UMIN000020538.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Dataset is available from the corresponding author at ktanabe2@hiroshima-u.ac.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kazuaki Tanabe, MD, PhD, Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. ktanabe2@hiroshima-u.ac.jp
Telephone: +81-82-2575222 Fax: +81-82-2575224
Received: December 26, 2015
Peer-review started: December 27, 2015
First decision: January 30, 2016
Revised: February 12, 2016
Accepted: March 14, 2016
Article in press: March 16, 2016
Published online: May 27, 2016
Processing time: 142 Days and 16.7 Hours
Abstract

AIM: To assess the safety of enhanced recovery after surgery (ERAS) program in gastrectomy and influences on nutrition state and insulin-resistance.

METHODS: Our ERAS program involved shortening the fasting periods and preoperative carbohydrate loading. Eighty gastrectomy patients were randomly assigned to either the conventional group (CG) or ERAS group (EG). We assessed the clinical characteristics and postoperative outcomes prospectively. The primary endpoint was noninferiority in timely discharge from the hospital within 12 d. Secondary endpoints were the incidence of aspiration at anesthesia induction, incidence of postoperative complications, health related quality of life (HRQOL) using the SF8 Health Survey questionnaire, nutrition state [e.g., albumin, transthyretin (TTR), retinal-binding protein (RBP), and transferrin (Tf)], the homeostasis model assessment-insulin resistance (HOMA-R) index, postoperative urine volume, postoperative weight change, and postoperative oral intake.

RESULTS: The ERAS program was noninferior to the conventional program in achieving discharge from the hospital within 12 d (95.0% vs 92.5% respectively; 95%CI: -10.0%-16.0%). There was no significant difference in postoperative morbidity between the two groups. Adverse events such as vomiting and aspiration associated with the induction of general anesthesia were not observed. There were no significant differences with respect to postoperative urine volume, weight change, and oral intake between the two groups. EG patients with preoperative HOMA-R scores above 2.5 experienced significant attenuation of their HOMA-R scores on postoperative day 1 compared to CG patients (P = 0.014). There were no significant differences with respect to rapid turnover proteins (TTR, RBP and Tf) or HRQOL scores using the SF8 method.

CONCLUSION: Applying the ERAS program to patients who undergo gastrectomy is safe, and improves insulin resistance with no deterioration in QOL.

Keywords: Gastrectomy; Carbon hydrogen oxygen; Insulin resistance; Enhanced recovery after surgery; Randomized controlled trial

Core tip: We conducted a prospective study in gastrectomy patients to evaluate the efficacy of enhanced recovery after surgery (ERAS) programs. ERAS was safe and improved insulin resistance in these patients.