title: Enhanced recovery (ERAS) protocol in patients undergoing laparoscopic total gastrectomy.
abstract: BACKGROUND
  Laparoscopic technique combined with the ERAS (Enhanced Recovery after Surgery) protocol enables a shorter hospital stay and a lower complication rate. Although it has been widely used in many patients undergoing elective abdominal surgery, especially in patients with colorectal cancer, there are only a few papers describing laparoscopic total gastrectomy and the enhanced recovery protocol in patients with gastric cancer. Minimally invasive gastrectomy is still an uncommon procedure, mostly because of its difficulty.
  
  
  OBJECTIVE
  To present the preliminary results of treatment of patients with gastric neoplasms who underwent laparoscopic gastrectomy D2 with perioperative care according to ERAS principles.
  
  
  METHODS
  Eleven patients (5 male and 6 female, age 52-77 years) underwent laparoscopic D2 gastrectomy with intracorporeal esophagojejunal anastomosis. In all patients the ERAS protocol was implemented. We analyzed operation time, complications and hospital stay. Additionally we focused on operative technique as well as the perioperative care protocol.
  
  
  RESULTS
  The mean duration of the procedure was 245 min. There was 1 conversion due to unclear tumor infiltration. Mean hospital stay was 4.6 days. One postoperative complication (central venous catheter sepsis) was reported. Histological analysis confirmed the tentative diagnosis (R0 resection) in 10/11 patients. There were no readmissions.
  
  
  CONCLUSIONS
  Laparoscopic gastrectomy is a valuable alternative to the classical approach and combined with the ERAS protocol can result in reduced hospital stay. However, due to the small group of patients it is difficult to adequately assess the incidence of early and late complications of the laparoscopic procedures; therefore further research is needed.
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland ; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Krakow, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland ; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Krakow, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland ; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Krakow, Poland.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kisialeuski
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland ; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland ; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Migaczewski
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland ; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Budzyński
authors.affiliation: Department of Oncology, University Hospital, Krakow, Poland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ochenduszko
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Rembiasz
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland ; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
keywords: enhanced recovery; fast-track; gastrectomy; laparoscopy; postoperative care
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