Survey of Perioperative Practices in Gastric Cancer Surgery for Establishing an Enhanced Recovery After Surgery Program Across 10 Tertiary Hospitals in South Korea

Abstract

Purpose: This study aimed to identify the current perioperative management practices for gastric cancer surgery in South Korea and develop a consensus-driven Enhanced Recovery After Surgery (ERAS) protocol for a multicenter randomized controlled trial (RCT).

Materials and methods: A survey was conducted with 20 principal investigators, comprising one gastric surgeon and one anesthesiologist each, from 10 tertiary hospitals in South Korea who participated in a planned multicenter RCT. The survey included 41 questions regarding ERAS implementation and department-specific perioperative management practices. The responses were analyzed using descriptive statistics, and the findings were used to develop a consensus-driven ERAS protocol.

Results: A total of 20 participants completed the survey. Most respondents estimated the overall compliance rate with ERAS protocols for gastric cancer surgery to be 30%-50%. A major barrier to ERAS implementation is limited personnel resources. The survey revealed significant variability in perioperative practices-particularly in postoperative oral feeding protocols and expected discharge dates-across institutions. Most institutions practice water fasting from midnight before surgery, and the adoption rate of multimodal opioid-sparing analgesia is low. Based on these findings, an ERAS protocol was established through collaborative discussions to shorten perioperative fasting periods and implement multimodal opioid-sparing analgesia.

Conclusions: This study revealed significant variability in the perioperative management of gastric cancer surgery in South Korea. A consensus-driven ERAS protocol was established to standardize care and promote functional recovery. Its feasibility and effectiveness should be evaluated in an upcoming multicenter RCT.