Abstract:
Introduction: Enhanced Recovery After Surgery (ERAS) protocols represent a paradigm shift in perioperative care, focusing on evidence-based practices to reduce surgical stress, optimize pain management, and accelerate postoperative recovery. Initially developed for colorectal surgery, ERAS protocols have been increasingly adopted across various oncologic surgeries, including gastrointestinal, gynaecologic, and hepatopancreatobiliary procedures. The implementation of ERAS protocols in cancer surgery aims to minimize postoperative complications, shorten hospital stays, and enhance patients' overall recovery. This case report illustrates the application and benefits of an ERAS protocol in a patient undergoing gastrectomy for gastric cancer, highlighting its potential for improving postoperative outcomes and promoting early return to normal activities.
Case Report: A 62-year-old male with a history of early-stage gastric adenocarcinoma presented to our institution for definitive surgical management. Following staging investigations, including CT and endoscopic ultrasound, the tumour was classified as cT2N0M0. After multidisciplinary discussion, the patient was scheduled for a laparoscopic distal gastrectomy with D2 lymphadenectomy. Given the patient's comorbidities, including controlled hypertension and Type 2 diabetes, the decision was made to implement an ERAS protocol to optimize perioperative care.
The ERAS protocol included preoperative counselling, carbohydrate loading up to two hours before surgery, avoidance of prolonged fasting, minimally invasive surgery, opioid-sparing analgesia using epidural anaesthesia, early ambulation, and initiation of oral intake on postoperative day one. Intraoperatively, goal-directed fluid therapy was used to maintain euvolemia, and a laparoscopic approach was employed to minimize surgical trauma. Postoperatively, pain was managed using multimodal analgesia, including paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), supplemented by epidural analgesia.
The patient's postoperative course was uneventful, with early mobilization initiated on the day of surgery and advancement to a soft diet by postoperative day two. The patient was discharged on postoperative day four, significantly earlier than the average length of stay for similar procedures without ERAS protocols. At the two-week follow-up, the patient reported minimal pain, good functional recovery, and no postoperative complications.
Results: The adoption of the ERAS protocol in this case led to a substantial reduction in hospital stay, enhanced patient recovery, and minimized complications. By focusing on early mobilization, multimodal analgesia, and accelerated nutritional support, the ERAS protocol facilitated a smoother postoperative course and a quicker return to daily activities. The patient experienced a high level of satisfaction, with no readmissions or delays in adjuvant therapy initiation.
Conclusion: ERAS protocols have become an integral part of oncologic surgery due to their ability to reduce surgical stress, minimize opioid use, and accelerate recovery. This case demonstrates the benefits of ERAS implementation in gastric cancer surgery, supporting its broader adoption in diverse oncologic procedures. By reducing complications and enhancing recovery, ERAS protocols offer a significant advancement in perioperative care, potentially improving both short- and long-term outcomes for cancer patients. As ERAS principles continue to evolve, ongoing research is needed to optimize these protocols, tailor them to specific cancer types, and assess their impact on long-term oncological outcomes. The widespread adoption of ERAS protocols in cancer surgery represents a move toward more patient-centered and evidence-based care in the surgical field.
Audience Take Away Notes:
- Key Components of ERAS Protocols: Learn about preoperative, intraoperative, and postoperative elements that optimize recovery in cancer surgery.
- Benefits of ERAS in Oncology: Understand how ERAS reduces complications, hospital stays, and costs while improving patient outcomes.
- Practical Implementation of ERAS: Gain insights into multidisciplinary strategies and overcoming challenges in ERAS adoption.
- Evidence Across Cancer Surgeries: Review research and case studies showcasing ERAS benefits in different oncologic procedures.
- Future of ERAS Protocols: Explore advancements and optimization of ERAS for personalized cancer care and improved long-term outcomes.
