A Feasibility Study of One Clinical Pathway for Both Distal and Total Gastrectomy

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  • NOZAKI Isao
    Department of Surgery, Shikoku Cancer Center
  • GOTOHDA Naoto
    Department of Surgery, National Cancer Center Hospital East
  • FUJIYA Tsuneaki
    Department of Surgery, Miyagi Cancer Center
  • FUKUSHIMA Norimasa
    Department of Surgery, Yamagata Prefectural Central Hospital
  • FUJITA Junya
    Department of Surgery, Toyonaka Municipal Hospital Department of Surgery, NTT West Osaka Hospital
  • ITO Seiji
    Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
  • OSHITA Hiroo
    Department of Surgery, Gifu Municipal Hospital Department of Surgery, Ogaki Tokushukai Hospital
  • KAWAMURA Susumu
    Department of Plastic Surgery, Shikoku Cancer Center
  • WAKAO Fumihiko
    Center for Cancer Control and Information Services, National Cancer Center
  • KURITA Akira
    Department of Surgery, Shikoku Cancer Center

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Other Title
  • 幽門側胃切除と胃全摘の両術式に利用可能なクリニカルパス
  • ユウモンガワ イ セツジョ ト イ ゼンテキ ノ リョウ ジュツシキ ニ リヨウ カノウ ナ クリニカルパス

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Abstract

We previously reported that the new standardized clinical pathways for distal gastrectomy (DG-path : restarting semi-solid food on postoperative day 3 and discharging on postoperative day 8-14) and for total gastrectomy (TG-path : restarting semi-solid food on postoperative day 4 and discharging on postoperative day 9-16) could be used safely. If DG-path can apply to TG safely, it will promote an early hospital discharge to TG patients and will make perioperative treatments for both DG and TG simpler and more convenient. We have conducted a multicentric study to clarify whether DG-path can be used safely for TG. The DG-path was followed in 167 TG patients. Then their clinical outcomes and clinical pathway variance were compared with those of 161 TG patients who followed the TG-path in the previous study. The median postoperative hospital stay was shorter in the DG-path (13 days) than in the TG-path (14 days). The incidence of severe complications was lower in the DG-path (4.2%) than in the TG-path (6.8%). Our outcomes suggest that DG-path can be used safely following TG without increasing postoperative complications. In conclusion, DG-path can be used for both DG and TG safely.

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