Consensus guidelines for enhanced recovery after gastrectomy

TLDR

Evidence‑based perioperative care protocols reduce complications, speed recovery, and shorten stay, yet no comprehensive guidelines exist for gastrectomy. To develop an evidence‑based comprehensive framework for perioperative care of patients undergoing gastrectomy. The group reviewed literature from standard databases and archives, classified evidence using the GRADE system, and reached consensus on recommendations. The guideline presents 25 recommendations (8 procedure‑specific), graded strong or weak, with variable evidence quality and calls for further research to strengthen evidence and support future trials.

Abstract

Application of evidence-based perioperative care protocols reduces complication rates, accelerates recovery and shortens hospital stay. Presently, there are no comprehensive guidelines for perioperative care for gastrectomy.An international working group within the Enhanced Recovery After Surgery (ERAS®) Society assembled an evidence-based comprehensive framework for optimal perioperative care for patients undergoing gastrectomy. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and were discussed until consensus was reached within the group. The quality of evidence was rated 'high', 'moderate', 'low' or 'very low'. Recommendations were graded as 'strong' or 'weak'.The available evidence has been summarized and recommendations are given for 25 items, eight of which contain procedure-specific evidence. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations.The present evidence-based framework provides comprehensive advice on optimal perioperative care for the patient undergoing gastrectomy and facilitates multi-institutional prospective cohort registries and adequately powered randomized trials for further research.