Abstract
Clinical pathway use in gastric cancer surgery has been widely accepted as a tool to guide evidence-based treatment. However, no standardized pathway has been accepted for nationwide use. If one could be developed and used safely, it will provide the same quality of perioperative treatment and may promote an earlier hospital discharge to all patients in Japan. Here we conducted a multi-centric study to develop and verify the new standardized clinical pathway for distal gastrectomy (DG-path) and for total gastrectomy (TG-path). We first developed a DG-path restarting solid food on postoperative day 3, while the TG-path started on day 4. Then, these pathways were followed by 415 DG patients and 163 TG patients. The clinical outcomes and clinical pathway variance of each group were analyzed. The median postoperative hospital stay was 12 days in the DG-path and 14 days in the TG-path. The discharge delay was observed to be 14.5% in the DG-path and 25.8% in the TG-path. However, the incidences of severe complications were relatively low at 3.9% in the DG-path and 6.7% in the TG-path. Our data suggests these pathways can be used with relative safety. These two pathways can be models for standardized clinical pathway for use nationwide.
