This study aimed to compare the effects of ERAS and conventional programs on short-term outcomes after laparoscopic distal gastrectomy (LDG).
Currently, the enhanced recovery after surgery (ERAS) program is broadly applied in surgical areas. Although several benefits of LDG with the ERAS program have been covered, high-level evidence is still limited, specifically in advanced gastric cancer (AGC).
The present study was designed as a randomized, multicenter, unblinded trial. The enrollment criteria included histologically confirmed cT2-4aN0-3M0 gastric adenocarcinoma. Postoperative complications, mortality, readmission, medical costs, recovery and laboratory outcomes were compared between the ERAS and conventional groups.
Between April 2019 and May 2020, 400 consecutive patients who met the enrollment criteria were enrolled. They were randomly allocated to either the ERAS group (n = 200) or the conventional group (n = 200). After excluding patients who did not undergo surgery or gastrectomy, 370 patients were analyzed. The patient demographic characteristics were not different between the two groups. The conventional group had a significantly longer allowed day of discharge and postoperative hospital stay (6.96 vs 5.83 days, P<0.001; 8.85 vs 7.27 days, P<0.001); a longer time to first flatus, liquid intake and ambulation (3.37 vs 2.52 days, P<0.001; 3.09 vs 1.13 days, P<0.001; 2.85 vs 1.38 days, P<0.001, respectively); and higher medical costs (6826 vs 6328 $, P = 0.027) than the ERAS group. Additionally, patients in the ERAS group were more likely to initiate adjuvant chemotherapy earlier (29 vs 32 days, P = 0.035). There was no significant difference in postoperative complications or in the mortality or readmission rates. Regarding laboratory outcomes, the procalcitonin and C-reactive protein levels on postoperative day (POD) 3 were significantly lower and the hemoglobin levels on POD5 were significantly higher in the ERAS group than in the conventional group.
The ERAS program provides a faster recovery, a shorter postoperative hospitalization length, and lower medical costs after LDG without increasing complication and readmission rates. Moreover, enhanced recovery in the ERAS group enables early initiation of adjuvant chemotherapy.

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