Abstract
BACKGROUND: The enhanced recovery after surgery (ERAS) perioperative management framework has been well-documented to improve surgical outcomes and alleviate financial burdens for patients. Against the backdrop of a rapidly aging global population, the incidence of gastric cancer (GC) among elderly individuals continues to increase. AIM: To validate the feasibility and safety of the ERAS protocol in elderly GC patients, thereby enhancing its evidence-based medical foundation. METHODS: A retrospective analysis of 161 GC patients who underwent ERAS between January 2022 and January 2024 was conducted. The subjects included 79 young patients (< 65 years) and 82 elderly patients (≥ 65 years). The rates of ERAS compliance, postoperative ventilation time, postoperative hospital stay, reoperation rate, mortality rate, postoperative inflammatory markers C-reactive protein (CRP), white blood cells (WBCs), IL-2, IL-6, and the rate of postoperative complications (anastomotic leakage, incision infection, pulmonary infection) were compared between these two groups. RESULTS: The incidence of complications in the elderly group was significantly higher than that in the young group, and included hypertension (P = 0.002), diabetes (P = 0.005), respiratory disease (P = 0.034), and heart disease (P = 0.016). In terms of American Society of Anesthesiologists (ASA) grading indicators, the overall ASA grade in the elderly group was biased toward grade II, which was significantly higher than that in the young group (P < 0.001). There was no significant difference in sex, body mass index, preoperative albumin, preoperative WBCs, TNM classification, differentiation, number of lymph node metastasis, and preoperative IL-6 between the two groups. There were no significant differences between the two groups in terms of operative method, surgical approach, conversion to open surgery, operation time, intraoperative bleeding volume, and number of lymph nodes dissected (all P values > 0.05). There were no significant differences between the two groups in ERAS completion rate, reoperation, postoperative first ventilation time, postoperative hospital stays, postoperative anastomotic leakage, postoperative incision infection, postoperative pulmonary infection, and serum inflammatory markers (WBCs, CRP and IL-6) on postoperative day 1 and 3 (all P values > 0.05). No patients in either group died within 30 days after surgery. CONCLUSION: The application of ERAS protocols in elderly patients is feasible and safe, and its management measures are universally applicable to patients of different ages.