Nationwide field evaluation of early oral intake following gastric cancer surgery.

BACKGROUND

Early oral intake (EOI) is a core component of Enhanced Recovery After Surgery (ERAS) protocols. Although EOI after gastrectomy has been shown to improve recovery and reduce postoperative complications, its real-world implementation across Japan remains unclear. This study aimed to evaluate the current status and institutional factors influencing EOI after gastric cancer surgery using a nationwide database.

METHODS

This retrospective observational study used Japan's nationwide Diagnosis Procedure Combination (DPC) database to analyze 26,097 patients who underwent gastric cancer surgery at 472 institutions from 2017 to 2022. Patients were divided into EOI and non-EOI groups based on oral intake initiation within two days postoperatively. Surgical methods, hospital characteristics, and length of stay were compared.

RESULTS

Only 20.8 % of patients initiated EOI. Laparoscopic distal gastrectomy had significantly higher EOI rates compared to open procedures. However, no significant difference was observed for proximal or total gastrectomy. Larger hospitals and designated cancer centers showed higher EOI rates. The EOI group had a significantly shorter postoperative stay (median 9 vs. 12 days, p < 0.001).

CONCLUSIONS

EOI following gastrectomy is associated with shorter hospitalization, yet its adoption remains low in Japan. Institutional factors and multidisciplinary collaboration may play crucial roles in promoting EOI. Findings may inform perioperative optimization and ERAS standardization in oncologic gastric surgery.