title: Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial.
abstract: 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 fast-track surgery in laparoscopic distal gastrectomy.
  
  
  METHODS
  The present study was designed as a single-center, randomized, unblinded, parallel-group trial. Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated. The fast-track 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  We randomized 47 patients into a fast-track group (n=22) and a conventional pathway group (n=22), with three patients withdrawn.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 fast-track 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.
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea. drholy@gmail.com
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Whan Sik
authors.initials: WS
authors.lastname: Kim
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Cheong
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D004434:Early Ambulation; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods / Q000534:rehabilitation*; D005763:Gastroenterostomy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine