ERAS pathway adherence and its association with return to intended oncological therapy after gastrectomy

IF 2.1 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2026-02-01 Epub Date: 2025-12-27 DOI:10.1016/j.suronc.2025.102346

Ana León Bretscher , Javier Ripollés Melchor , María García Nebreda , Ane Abad Motos , Carla Iglesias Morales , José María Tena Guerrero , Cristina Gil Lapetra , Francisco José Orts Micó , Manuel Llácer Pérez , Patricia Galán Menéndez , Enrique Alday-Muñoz , Jorge Puertas Domínguez , Bakarne Ugarte Sierra , Ana Maria Pascual Bellosta , Rosalia Navarro-Perez , Raquel Risco , Virginia Moreno Blanco , Raquel García Álvarez , Irene Mojarro Zamora , Alfredo Abad Gurumeta , Gloria Paseiro Crespo

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引用次数: 0

Abstract

Background

Enhanced Recovery After Surgery (ERAS) pathways improve short-term outcomes in abdominal surgery, but their impact on timely initiation of adjuvant chemotherapy (Return to Intended Oncologic Therapy, RIOT) in gastric cancer remains uncertain.

Methods

This multicenter, prospective cohort study (POWER4, NCT03865810) analysed 742 patients undergoing gastrectomy across 72 Spanish hospitals (2019–2020). ERAS adherence was assessed by quartiles. Primary outcome: timely RIOT (chemotherapy initiation ≤56 days post-surgery). Secondary outcome: time to RIOT (days). Multivariable logistic and Cox regression models adjusted for clinical/tumour factors.

Results

Of 742 patients, 65 % achieved timely RIOT. Quartile-based univariable analysis revealed shorter time to RIOT with higher adherence (Q4 vs. Q1: HR 0.64, 95 % CI 0.42–0.97, *p* = 0.034), but this association disappeared in multivariable models. Advanced TNM stage (e.g., IIIC: HR 18.6, *p* < 0.001) and ASA class were stronger predictors of delayed RIOT.

Conclusions

While ERAS pathways may aid recovery, their impact on RIOT depends on high adherence and is overshadowed by tumour-related factors. Future efforts should integrate ERAS with prehabilitation for high-risk patients and target adherence thresholds ≥70 %.

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ERAS通路依从性及其与胃切除术后肿瘤治疗恢复的关系

手术后增强恢复（ERAS）途径改善了腹部手术的短期预后，但其对胃癌患者及时开始辅助化疗（返回预期肿瘤治疗，RIOT）的影响仍不确定。方法这项多中心前瞻性队列研究（POWER4, NCT03865810）分析了西班牙72家医院（2019-2020年）的742例胃切除术患者。ERAS依从性以四分位数评估。主要终点：及时的RIOT（化疗开始≤术后56天）。次要结果：发生暴动的时间（天）。多变量logistic和Cox回归模型调整临床/肿瘤因素。结果742例患者中，65%的患者获得了及时的RIOT。基于四分位数的单变量分析显示，依从性越高，RIOT时间越短（Q4 vs. Q1: HR 0.64, 95% CI 0.42-0.97, *p* = 0.034），但这种关联在多变量模型中消失。晚期TNM分期（如IIIC: HR 18.6, *p* < 0.001）和ASA等级是延迟性RIOT的较强预测因子。虽然ERAS途径可能有助于恢复，但其对RIOT的影响取决于高依从性，并被肿瘤相关因素所掩盖。未来的努力应将ERAS与高危患者的康复结合起来，目标依从性阈值≥70%。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.