Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: A randomized clinical trial

Background Fast-track surgery has been shown to enhance postoperative recovery in several surgical fields. This study aimed to evaluate the safety and efficacy of fasttrack surgery in laparoscopic distal gastrectomy. Methods The present study was designed as a singlecenter, randomized, unblinded, parallel-group trial. Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated. The fasttrack surgery protocol included intensive preoperative education, a short duration of fasting, a preoperative carbohydrate load, early postoperative ambulation, early feeding, and sufficient pain control using local anesthetics perfused via a local anesthesia pump device, with limited use of opioids. The primary endpoint was the duration of possible and actual postoperative hospital stay. Results We randomized 47 patients into a fast-track group (n = 22) and a conventional pathway group (n = 22), with three patients withdrawn. The possible and actual postoperative hospital stays were shorter in the fasttrack group than in the conventional group (4.68 ± 0.65 vs. 7.05 ± 0.65; P <0.001 and 5.36 ± 1.46 vs. 7.95 ± 1.98; P <0.001). The time to first flatus and pain intensity were not different between groups; however, a greater frequency of additional pain control was needed in the conventional group (3.64 ± 3.66 vs. 1.64 ± 1.33; P = 0.023). The fast-track group was superior to the conventional group in several factors of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, including: fatigue, appetite loss, financial problems, and anxiety. The complication and readmission rates were similar between groups. Conclusions Fast-track surgery could enhance postoperative recovery, improve immediate postoperative quality of life, and be safely applied in laparoscopic distal gastrectomy.