Feasibility of Enhanced Recovery After Surgery Without Prophylactic Abdominal Drainage Tubes After Laparoscopic Distal Gastrectomy For Gastric Cancer

It refers to the total proportion of patients who, by the 30th day after their surgery, undergo either a reoperation or the placement of a percutaneous drainage device. The cumulative incidence considers all patients who experience one or both of these outcomes by the 30th day after surgery, providing insight into the postoperative recovery process.

Postoperative hospital stay is considered as a period from the time when a patient leaves the operating room to the point of time (8:00 am) on the day of discharge with no intervention treatment provided.

The intraoperative complications include surgery-related complications (intraoperative hemorrhage (≥400 mL) and injury of liver, spleen, pancreas, and other vital organs), pneumoperitoneum-related complications (hypercapnia, mediastinal emphysema, subcutaneous emphysema, and respiratory and circulatory instability caused by pneumoperitonum), and anesthesia-related complications (acute bronchospasm, aspiration, abnormal blood pressure and temperature, and allergic reaction). The postoperative complications are defined as any adverse events requiring surgical or medical interventions after surgery, including surgery-related complications (wound problems, anastomotic leakage, anastomotic hemorrhage, anastomotic stenosis, intra-abdominal hemorrhage, intra-abdominal abscess, ileus, gastroparesis, lymphatic leakage, unscheduled reoperation, and surgery-related readmission) and system-related complications (pulmonary infection, pulmonary embolism, cardio-cerebrovascular complications (includ

The 30 days readmission rate refers to the proportion of patients who are readmitted to a healthcare facility within 30 days after being discharged, attributable to postoperative complications. It is often used as a quality metric to assess healthcare effectiveness and the likelihood of complications or inadequate discharge planning. A higher readmission rate may indicate potential issues with the quality of care or patient management after discharge. The overall 90 days mortality refers to the proportion of patients who die within 90 days of either being admitted to or discharged from a healthcare facility, directly attributable to gastric cancer progression or surgery-related complications. This metric is used to evaluate the long-term survival rate of patients following their hospitalization and can serve as an indicator of the severity of the condition being treated, the effectiveness of treatment, and the overall healthcare system's ability to manage patients' long-term outcomes.

EORTC QLQ-C30 questionnaire scale is used to assess the quality of life in both two groups. The assessment will be performed preoperatively (baseline), and at 7th day and 1 month after surgery.

QoR-15 score is applied to evaluate the quality of recovery in both two groups. The evaluation will be conducted preoperatively (baseline), at 1st, 2nd, 3rd, 4th, 5th day after surgery and the day of discharge separately.

These time are defined as periods from the time when patients first return to the department after surgery to first out-of-bed activities, first anal exhaust, and first drinking sodium chloride aqueous solution separately. Operative time is defined as the interval from skin incision to skin closure.

Postoperative pain intensity is evaluated using the NRS score (0-10) and classified as no pain (0), mild pain (1-3), moderate pain (4-6), and severe pain (7-10). It is recorded from the day of surgery to the day of discharge.

The prognostic nutritional index (PNI) is an indicator, used to evaluate the nutritional status of patients and predict the risk of postoperative complications. It is calculated as peripheral blood lymphocyte count (109/L) × 5 + serum albumin value (g/L).

It is calculated as the total amount of medical expenses during the hospital stay for patients. The medical costs were strictly controlled in accordance with relevant regulations of the healthcare system, including the sum of all medically related expenses incurred during the patient's stay, such as bed charges, treatment fees, diagnostic and laboratory costs, medication, nursing, supplies, and other related expenses.