Outcomes of clinical pathway in laparoscopic and open surgical treatments for gastric cancer patients : Patients selection for fast-track program through retrospective analysis

Abstract

Background. The aim of this study is to investigate the clinical factors affecting on the complete rate from the clinical pathway in minimally invasive and open surgery for gastric cancer, and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis.

Methods. In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery from January 2011 to December 2011 and were managed with conventional clinical pathway. This clinical pathway was made as the patients in minimally invasive surgery group start the diet and discharge from hospital one day faster than them in open surgery group.

Results. The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than it in open group (P< .001).In multivariate analysis, the surgical procedure of minimally invasive surgery (Odd ratio = 4.281) was most predictable factor to complete clinical pathway. Additionally, younger patients (Odd ratio = 1.933) who underwent distal gastrectomy (Odd ratio = 1.999) without combined resection (Odd ratio = 3.069) were predicted to accomplish the clinical pathway without modifications.

Conclusion. We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (Expected complete rate = 85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.