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.