Perioperative multimodal behavioral optimization improves recovery and long-term outcomes after curative gastrectomy:...

Psychological resilience-the ability to adapt positively to adversity-has emerged as a key factor influencing cancer recovery and prognosis. In gastric cancer, reduced resilience is often accompanied by sleep disturbances and elevated systemic inflammation, impairing postoperative recovery and survival. However, the efficacy of targeted psychosocial interventions remains underexplored. Reporting follows CONSORT/EQUATOR (including TIDieR) guidance.

In this single-center randomized controlled trial, 280 patients with stage I-III gastric cancer undergoing curative gastrectomy were assigned to either standard perioperative care or an integrated intervention combining cognitive behavioral therapy, resilience training, and sleep hygiene education. The intervention was initiated perioperatively and continued for 3 months. Primary outcomes included psychological resilience (CD-RISC), sleep quality (PSQI), and emotional status (HADS). Secondary endpoints comprised inflammatory markers (CRP, IL-6, TNF-α), postoperative recovery metrics, and two-year disease-free (DFS) and overall survival (OS).

Compared to controls, the intervention group showed significantly greater improvements in CD-RISC, PSQI, and HADS scores (all p < 0.001; large effect sizes, d > 0.8), and reduced inflammatory markers. Enhanced recovery was reflected by shorter hospital stays and fewer major complications. Two-year survival outcomes favored the intervention: DFS 78.6% vs 64.3% (log-rank p = 0.006; HR = 0.58, 95% CI 0.37-0.91) and OS 84.3% vs 70.7% (log-rank p = 0.004; HR = 0.52, 95% CI 0.31-0.87).

A structured perioperative psychosocial program targeting resilience and sleep improved psychological outcomes, reduced inflammation, and enhanced recovery and survival after gastrectomy. Integration into ERAS pathways is supported, though the single-center design is a limitation.