ERAS pathway adherence and its association with return to intended oncological therapy after gastrectomy
Ana León Bretscher1, Javier Ripollés Melchor1, María García Nebreda1
1Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
Background:
Enhanced Recovery After Surgery (ERAS) pathways improve short-term outcomes in abdominal surgery, but their impact on timely initiation of adjuvant chemotherapy (Return to Intended Oncologic Therapy, RIOT) in gastric cancer remains uncertain.
Methods:
This multicenter, prospective cohort study (POWER4, NCT03865810) analysed 742 patients undergoing gastrectomy across 72 Spanish hospitals (2019-2020). ERAS adherence was assessed by quartiles.
Primary Outcome:
timely RIOT (chemotherapy initiation ≤56 days post-surgery).
Secondary Outcome:
time to RIOT (days). Multivariable logistic and Cox regression models adjusted for clinical/tumour factors.
Results:
Of 742 patients, 65 % achieved timely RIOT. Quartile-based univariable analysis revealed shorter time to RIOT with higher adherence (Q4 vs. Q1: HR 0.64, 95 % CI 0.42-0.97, *p* = 0.034), but this association disappeared in multivariable models. Advanced TNM stage (e.g.
, Iiic:
HR 18.6, *p* < 0.001) and ASA class were stronger predictors of delayed RIOT.
Conclusions:
While ERAS pathways may aid recovery, their impact on RIOT depends on high adherence and is overshadowed by tumour-related factors. Future efforts should integrate ERAS with prehabilitation for high-risk patients and target adherence thresholds ≥70 %.
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