Seoul National University Hospital Demonstrates Effectiveness of 'Enhanced Recovery After Surgery' Program for Gastric Cancer Patients

Faster Postoperative Recovery and Reduced Pain with ERAS Program for Gastric Cancer Surgery
Seoul National University Hospital research team demonstrates significant improvement in quality of recovery and decrease in opioid use

A research team at Seoul National University Hospital has found that applying the Enhanced Recovery After Surgery (ERAS) program to patients undergoing laparoscopic or robotic surgery for gastric cancer significantly improves the quality of postoperative recovery.

(From left) Professor Dojung Park, Department of Gastrointestinal Surgery, Seoul National University Hospital, and Professor Hojin Lee, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital. Seoul National University Hospital

According to Seoul National University Hospital on June 10, this study was conducted as a prospective randomized controlled clinical trial. The results showed that the quality of recovery improved, pain and opioid analgesic use decreased, and the length of hospital stay was reduced.

The research team, led by Professor Dojung Park from the Department of Gastrointestinal Surgery and Professor Hojin Lee from the Department of Anesthesiology and Pain Medicine at Seoul National University Hospital, developed a minimally invasive, gastric cancer-specific ERAS program tailored to the Korean clinical environment. From February 2023 to May 2024, they conducted a prospective randomized controlled clinical trial involving a total of 92 gastric cancer patients who underwent laparoscopic or robotic distal gastrectomy. The patients were divided into an ERAS group (45 patients) and a conventional care group (47 patients).

The ERAS program applied in this study consisted of minimizing pre- and postoperative fasting (including preoperative carbohydrate drinks), ultrasound-guided abdominal nerve blocks, a multimodal analgesia strategy including non-opioid analgesics, and management to prevent nausea and vomiting. Unlike conventional opioid-centered pain management, this program implemented a safer, evidence-based, and integrated recovery strategy.

The primary evaluation metric was the QoR-15K score (Korean version of the Quality of Recovery questionnaire, total score 0-150), measured at 24, 48, and 72 hours after surgery. Based on existing literature, the researchers considered a difference of at least 8 points to be a clinically significant improvement. As a result, the ERAS group recorded an average QoR-15K score 16 points higher than the conventional care group (95% confidence interval: 8.9-23.0, P<0.001), indicating a statistically and clinically significant improvement in the quality of postoperative recovery.

In secondary evaluation metrics, the ERAS group also showed overall better recovery outcomes. At 48 hours after surgery, the pain score when coughing was an average of 5 points in the conventional care group, compared to 3 points in the ERAS group. The amount of opioid analgesics used during the first 72 hours after surgery was reduced by about 40%, from an average of 1260μg in the conventional care group to 780μg in the ERAS group. The I-FEED score, reflecting recovery of bowel function, improved from an average of 3 points in the conventional care group to 1 point in the ERAS group at 24 hours after surgery. The time to first gas passage was also, on average, 21 hours faster in the ERAS group. The overall length of hospital stay was, on average, one day shorter in the ERAS group.

The research team evaluated that these results indicate the ERAS program not only effectively improves the quality of recovery for gastric cancer surgery patients, but also enables a shift from the conventional practice of excessive fasting and opioid-centered management to a more efficient and safer recovery model. They also explained that a reduction in hospital stay is expected to lead to social and economic cost savings.

Professor Hojin Lee stated, "Although excessive pre- and postoperative fasting and opioid-centered pain management are still widely used in Korea, this study has confirmed that a more evidence-based perioperative management strategy is effective. We aim to continue contributing to the establishment of new surgical management standards that prioritize quality of recovery."

Professor Dojung Park said, "This clinical trial is an important study that has demonstrated the effectiveness of an ERAS program specialized for gastric cancer patients through a randomized comparative approach. Currently, a multicenter collaborative study involving 10 hospitals nationwide is also underway, and we will work to establish a policy foundation so that this program can become the standard clinical guideline for gastric cancer surgery in Korea."

This study was conducted as part of the Cancer Conquest Research and Development Project supported by the Ministry of Health and Welfare and the National Cancer Center, and the results were published in a recent issue of the international journal 'International Journal of Surgery.'

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