Early Postoperative Intervention in Gastric Cancer Patients

Investigators are conducting a two-arm, multicenter, interventional study at Qilu Hospital of Shandong University and five other renowned hospitals in China. A total of 264 gastric cancer patients who have completed preoperative neoadjuvant therapy will be randomly assigned to either the control group or the experimental group.For control group,patients will receive standard ERAS discharge management, including routine discharge education; outpatient follow-up visits on postoperative day 7 and postoperative day 30; and emergency contact via hospital telephone or emergency department visits for urgent situations.For experimental group,in addition to standard ERAS discharge management, patients will receive multimodal structured interventions during follow-up visits targeting nutritional status, psychological status, and exercise status. Nutritional intervention: Routine postoperative oral nutritional supplements (ONS) will be provided, and patients with metabolic diseases such as diabetes will undergo strict glycemic control. Psychological intervention: Patients with a Hospital Anxiety and Depression Scale (HADS) score ≥ 8 will receive cognitive behavioral therapy (CBT), and those with a HADS score ≥ 11 will be referred for psychological consultation. Exercise intervention: Postoperative rehabilitation training will be guided according to different postoperative periods.During the study period, the incidence of complications within 30 days postoperatively and quality of postoperative recovery were statistically analyzed, among other outcomes.

Inclusion criteria

• Age 18-80 years;
• Histologically confirmed adenocarcinoma by preoperative pathology;
• Completed preoperative neoadjuvant therapy without obvious immune-related adverse events (irAEs);
• Patients with ycT3-4N+Mx disease deemed surgically resectable based on evaluation by gastroscopy, CT, PET-CT, and other imaging modalities;
• Signed informed consent and voluntary participation in this study;
• Standard ERAS (Enhanced Recovery After Surgery) management during the - perioperative period, with postoperative hospital stay ≤7 days.

Exclusion criteria

• Patients with central nervous system diseases or psychiatric disorders;
• Patients with severe diseases of other organ systems;
• Patients with recurrent infectious diseases or severe comorbidities;
• Patients requiring synchronous surgery for other diseases;
• Patients undergoing emergency surgery;
• Patients who developed any complication during hospitalization.