Disease-free survival after gastrectomy is not influenced by ERAS adherence.
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Ripollés-Melchor Javier, Abad-Motos Ane, León-Bretscher Ana, Espinosa Ángel V, Amoza-Pais Sonia, Herrero-Bogajo Maria Luz, Abad-Gurumeta Alfredo, de-la-Plaza-Llamas Roberto, Galán-Menéndez Patricia, Zorrilla-Vaca Andrés, González-López Rocío, Navarro-Pérez Rosalía, Jiménez-Viñas Carlos, Parreño-Manchado Felipe Carlos, Ruiz Escobar Alicia, Concepción-Martín Vanessa, Paseiro-Crespo Gloria, Acosta-Mérida María Asunción, Puech-de-Oriol María, Mayo-Ossorio María Ángeles, García-Nebreda María, Chaveli-Diaz Carlos, Fernández-Valdes-Bango Paula, Torres-Alfonso José Ramón, Barragan-Serrano Cristina, Aldecoa César, POWER4 Investigators Group
Аннотация
METHODS: This was a prespecified substudy of the POWER4 cohort, a prospective, multicentre investigation of perioperative care and outcomes in patients undergoing elective gastrectomy for gastric cancer. ERAS adherence was assessed using 22 predefined components and analysed as a binary (high vs. low), continuous (per 10-point increment), and quartile-based variable. The primary endpoint was DFS, defined as the time from surgery to recurrence or death. Kaplan-Meier estimates and multivariable Cox models were used to evaluate the association between ERAS adherence and DFS, adjusting for age, sex, ASA, BMI, nutritional risk, anaemia, chronic kidney disease, surgical approach, procedure type, operative time, and tumour stage.
RESULTS: Among 368 patients with complete oncologic follow-up, the median follow-up was 1616 days. Kaplan-Meier curves suggested a trend toward improved DFS with higher ERAS adherence (log-rank p = 0.10 for binary comparison; p = 0.05 across quartiles). In multivariable Cox models, ERAS adherence was not significantly associated with DFS. Prognosis was independently predicted by tumour stage, chronic kidney disease, ASA ≥ III, and total gastrectomy.
CONCLUSION: In this multicentre cohort, ERAS adherence was not independently associated with long-term DFS after gastrectomy for gastric cancer. Long-term prognosis appeared primarily driven by tumour and patient-related factors rather than perioperative protocol adherence. The study was registered on Clinicaltrials.gov: NCT06790238.