Safety and Efficacy of Fast‐track Surgery in Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Clinical Trial

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We randomized 47 patients into a fast‐track group (<jats:italic>n</jats:italic> = 22) and a conventional pathway group (<jats:italic>n</jats:italic> = 22), with three patients withdrawn.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; <jats:italic>P</jats:italic> < 0.001 and 5.36 ± 1.46 vs. 7.95 ± 1.98; <jats:italic>P</jats:italic> < 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; <jats:italic>P</jats:italic> = 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Fast‐track surgery could enhance postoperative recovery, improve immediate postoperative quality of life, and be safely applied in laparoscopic distal gastrectomy.</jats:p></jats:sec>