Short-term postoperative outcomes before and after the establishment of the Siriraj upper gastrointestinal cancer center: A propensity score matched analysis

Abstract

© 2020 Faculty of Medicine Siriraj Hospital, Mahidol University. Objective: To evaluate short-term postoperative outcomes compared between before and 1 year after the establishment of the Siriraj Upper Gastrointestinal Cancer Center (UGICC). Methods: Medical records of 211 adenocarcinoma of stomach (GC) and esophagogastric junction (AEG) patients who underwent radical gastrectomy at Siriraj Hospital during January 2012-September 2018 were reviewed (before UGICC; B-UGICC). Data of 40 patients operated upon during October 2018-September 2019 were prospectively collected after the establishment of UGICC (A-UGICC). Propensity score (PPS) matched analysis was conducted, and short-term outcomes were compared. Enhanced Recovery After Surgery (ERAS) protocol was applied to some patients in A-UGICC. Results of conventional care (CC) were compared with ERAS protocol. Results: PPS matched 78 patients (13 AEG, 65 GC) in B-UGICC, and 40 patients (6 AEG, 34 GC) in A-UGICC. Median postoperative length of stay (POS) was significantly shorter in A-UGICC than in B-UGICC; however, complications and time to oral diet tolerability were not significantly different between groups. In A-UGICC, median POS and time to toleration of oral diet were significantly shorter among 15 ERAS patients than among 25 CC patients. Intestinal recovery and time to ambulation trended to be earlier in ERAS. Regarding the ERAS outcomes, 103 CC and 15 ERAS patients were matched to 36 non-ERAS and 13 ERAS patients. Median time to toleration of oral water, liquid diet, and solid diet was significantly shorter in ERAS than in CC (all P<0.001). Median POS was significantly shorter in ERAS (P<0.001). Postoperative complications were non-significantly different between ERAS and CC. There was no mortality in this study. Conclusion: UGICC with multidisciplinary team approach and application of ERAS protocol contributed to improvement of postoperative short-term outcomes.