Background/Objectives: Gastric cancer remains a leading cause of cancer-related deaths worldwide and surgical resection represents the mainstay of treatment procedures. However, despite the advancements noted in the field of surgical oncology, perioperative complications and variability in the perioperative care provided persist. To address the challenges caused by non-standardized perioperative care for gastric surgery across European healthcare systems, the EUropean PErioperative MEdical Networking (EUPEMEN) protocol has been developed. The present study concisely provides the EUPEMEN protocol's development, implementation, and impact on perioperative management in gastric resections. Methods: The EUPEMEN protocol was developed through a multidisciplinary collaboration involving five academic healthcare professionals from four European countries. The main activities of the collaborative group included a literature review, consensus development, the creation of multimodal rehabilitation manuals, and the development of an online learning platform. The EUPEMEN project aims for the uniform adoption of evidence-based practices across preoperative, intraoperative, and postoperative phases, leading in nutritional, psychological, and physiological optimization. Results: The implementation of the EUPEMEN protocol aims to optimize perioperative outcomes, including reduced postoperative complications, a shorter length of hospitalization, and improved recovery trajectories. The above have been achieved through structured guidelines that ensure consistent care delivery across diverse healthcare settings and tools such as rehabilitation manuals and a free-access online educational platform. Conclusions: The EUPEMEN protocol represents a new standard for perioperative care in the field of gastric surgery that is based on multidisciplinary collaboration and evidence-based practices. While challenges such as resource constraints and variability in adherence remain, the protocol demonstrates significant potential to improve patient outcomes and streamline perioperative management. Future research should focus on long-term effects and adaptation challenges in the setting of non-European healthcare systems.

4th Department of Surgery Faculty of Health Sciences Medical School Aristotle University of Thessaloniki General Hospital George Papanikolaou 57010 Thessaloniki Greece

Department of Anesthesia Resuscitation and Pain Therapy Miguel Servet University Hospital 50009 Zaragoza Spain

Department of Plastic Surgery 2nd Faculty of Medicine Charles University and Motol University Hospital 150 06 Prague Czech Republic

Department of Surgery 2nd Faculty of Medicine Charles University and Motol University Hospital 150 06 Prague Czech Republic

Department of Surgery Azienda Unità Sanitaria Locale Ferrara University of Ferrara 44121 Ferrara Italy

Department of Surgery Faculty of Medicine University of Zaragoza 50009 Zaragoza Spain

Department of Surgery Universidad Miguel Hernández Elche Hospital General Universitario Elche 03203 Elche Spain

Department of Surgery University Hospital Kralovske Vinohrady 100 34 Prague Czech Republic

Grupo Español de Rehabilitación Multimodal 50009 Zaragoza Spain

Institute for Health Research Aragón 50009 Zaragoza Spain

See more in PubMed

Yang W., Zhao H., Yu Y., Wang J., Guo L., Liu J., Pu J., Lv J. Updates on Global Epidemiology, Risk and Prognostic Factors of Gastric Cancer. World J. Gastroenterol. 2023;29:2452–2468. doi: 10.3748/wjg.v29.i16.2452. PubMed DOI PMC

Macdonald J.S. Treatment of Localized Gastric Cancer. Semin. Oncol. 2004;31:566–573. doi: 10.1053/j.seminoncol.2004.04.022. PubMed DOI

Shannon A.B., Straker R.J., Fraker D.L., Roses R.E., Miura J.T., Karakousis G.C. Ninety-Day Mortality after Total Gastrectomy for Gastric Cancer. Surgery. 2021;170:603–609. doi: 10.1016/j.surg.2021.02.010. PubMed DOI

Desiderio J., Trastulli S., D’Andrea V., Parisi A. Enhanced Recovery after Surgery for Gastric Cancer (ERAS-GC): Optimizing Patient Outcome. Transl. Gastroenterol. Hepatol. 2020;5:11. doi: 10.21037/tgh.2019.10.04. PubMed DOI PMC

Smith T.W.J., Wang X., Singer M.A., Godellas C.V., Vaince F.T. Enhanced Recovery after Surgery: A Clinical Review of Implementation across Multiple Surgical Subspecialties. Am. J. Surg. 2020;219:530–534. doi: 10.1016/j.amjsurg.2019.11.009. PubMed DOI

Rosa F., Longo F., Pozzo C., Strippoli A., Quero G., Fiorillo C., Mele M.C., Alfieri S. Enhanced Recovery after Surgery (ERAS) versus Standard Recovery for Gastric Cancer Patients: The Evidences and the Issues. Surg. Oncol. 2022;41:101727. doi: 10.1016/j.suronc.2022.101727. PubMed DOI

Ioannidis O., Anestiadou E., Ramirez J.M., Fabbri N., Mart J., Feo C.V., Pesce A., Rosetzka K., Arroyo A., Koci P., et al. The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Acute Appendicitis: Recommendations for Perioperative Care. J. Clin. Med. 2024;13:6943. doi: 10.3390/jcm13226943. PubMed DOI PMC

Pesce A., Ramírez J.M., Fabbri N., Ubieto J.M., Vittorio F.C. The EUropean PErioperative MEdical Networking (EUPEMEN) Project and Recommendations for Perioperative Care in Colorectal Surgery: A Quality Improvement Study. Int. J. Surg. 2024;110:4796–4803. doi: 10.1097/JS9.0000000000001601. PubMed DOI PMC

Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71. PubMed DOI PMC

Fish L.S., Busby D.M. The Delphi Method. Guilford; New York, NY, USA: 2005.

Ioannidis O., Ramirez J.M., Ubieto J.M., Feo C.V., Arroyo A., Kocián P., Sánchez-Guillén L., Bellosta A.P., Whitley A., Enguita A.B., et al. The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care. J. Clin. Med. 2023;12:4185. doi: 10.3390/jcm12134185. PubMed DOI PMC

Calvo-Vecino J., Hernández E., Ramirez J., Loinaz C., Trapero C., Quintas C., Antolín A., Rodriguez-Cuellar E., Aguado J., Ruiz-López P., et al. Vía Clínica de Recuperación Intensificada En Cirugía Abdominal (RICA) Instituto Aragonés de Ciencias de la Salud; Zaragoza, Spain: 2014.

Stenberg E., Dos Reis Falcão L.F., O’Kane M., Liem R., Pournaras D.J., Salminen P., Urman R.D., Wadhwa A., Gustafsson U.O., Thorell A. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J. Surg. 2022;46:729–751. doi: 10.1007/s00268-021-06394-9. PubMed DOI PMC

Oberoi M., Noor M.S., Abdelfatah E. The Multidisciplinary Approach and Surgical Management of GE Junction Adenocarcinoma. Cancers. 2024;16:288. doi: 10.3390/cancers16020288. PubMed DOI PMC

Li S.S., Costantino C.L., Mullen J.T. Morbidity and Mortality of Total Gastrectomy: A Comprehensive Analysis of 90-Day Outcomes. J. Gastrointest. Surg. 2019;23:1340–1348. doi: 10.1007/s11605-019-04228-7. PubMed DOI

de Cássio Zequi S., Franca Silva I.L.A., Duprat J.P., Coimbra F.J.F., Gross J.L., Vartanian J.G., Makdissi F.B.A., Leite F.P.M., Costa W.H.d., Yazbek G., et al. Informed Consent and a Risk-Based Approach to Oncologic Surgery in a Cancer Center during the COVID-19 Pandemic. J. Surg. Oncol. 2021;123:1659–1668. doi: 10.1002/jso.26452. PubMed DOI PMC

McNally S.A., El-Boghdadly K., Kua J., Moonesinghe S.R. Preoperative Assessment and Optimisation: The Key to Good Outcomes after the Pandemic. Br. J. Hosp. Med. 2021;82:1–6. doi: 10.12968/hmed.2021.0318. PubMed DOI

Mahendran S., Thiagalingam A., Hillis G., Halliwell R., Pleass H.C.C., Chow C.K. Cardiovascular Risk Management in the Peri-Operative Setting. Med. J. Aust. 2023;219:30–39. doi: 10.5694/mja2.51988. PubMed DOI

Diaz-Fuentes G., Hashmi H.R.T., Venkatram S. Perioperative Evaluation of Patients with Pulmonary Conditions Undergoing Non-Cardiothoracic Surgery. Health Serv. Insights. 2016;9:9–23. doi: 10.4137/HSI.S40541. PubMed DOI PMC

Kouyoumdjian A., Trepanier M., Al Shehhi R., Cools-Lartigue J., Ferri L.E., Lee L., Mueller C.L. The Effect of Preoperative Anemia and Perioperative Transfusion on Surgical Outcomes After Gastrectomy for Gastric Cancer. J. Surg. Res. 2021;259:523–531. doi: 10.1016/j.jss.2020.10.003. PubMed DOI

Peng D., Xiang Y.C., Tang K.L., Qiu Y.Y. Impact of Preoperative Type 2 Diabetes Mellitus on the Outcomes of Patients with Gastric Cancer Following Gastrectomy: Analysis of 834 Patients Using Propensity Score Matching. Biomed. Rep. 2023;19:1–6. doi: 10.3892/br.2023.1679. PubMed DOI PMC

Hezkial M., Al-bazzaz O., Farag M. Pre-Operative Haemoglobin A1c (HbA1c) in Diabetic Patients Undergoing Major Surgery: An Investigation into Current Practice. Perioper. Care Oper. Room Manag. 2018;13:6–11. doi: 10.1016/j.pcorm.2018.10.003. DOI

Cheisson G., Jacqueminet S., Cosson E., Ichai C., Leguerrier A.-M., Nicolescu-Catargi B., Ouattara A., Tauveron I., Valensi P., Benhamou D. Perioperative Management of Adult Diabetic Patients. Preoperative Period. Anaesthesia, Crit. Care Pain Med. 2018;37((Suppl. S1)):S9–S19. doi: 10.1016/j.accpm.2018.02.020. PubMed DOI

Son Y., Kwon I.G., Ryu S.W. Assessment of Nutritional Status in Laparoscopic Gastrectomy for Gastric Cancer. Transl. Gastroenterol. Hepatol. 2017;2:85. doi: 10.21037/tgh.2017.09.08. PubMed DOI PMC

Matsui R., Inaki N., Tsuji T. Impact of Preoperative Nutritional Assessment on Other-Cause Survival after Gastrectomy in Patients with Gastric Cancer. Nutrients. 2023;15:3182. doi: 10.3390/nu15143182. PubMed DOI PMC

Monteiro-grillo I., Camilo M., Ravasco P., Bole C. Validation of the Malnutrition Universal Screening Tool (MUST) in Cancer. Br. J. Nutr. 2021;108:343–348. doi: 10.1017/S000711451100571X. PubMed DOI

Oh S.E., Youn H.G., Oh S.J., Choi M.-G., Lee J.H., Sohn T.S., Bae J.M., An J.Y. Trends in Vitamin D Level and Risk of Vitamin D Deficiency after Gastrectomy for Gastric Cancer: A Retrospective Study of a Single High-Volume Center Experience. Clin. Nutr. ESPEN. 2023;53:74–79. doi: 10.1016/j.clnesp.2022.11.011. PubMed DOI

Ao M., Awane M., Asao Y., Kita S., Miyawaki T., Tanaka K. High Prevalence of Vitamin B-12 Deficiency before and Early after Gastrectomy in Patients with Gastric Cancer. Asia Pac. J. Clin. Nutr. 2023;32:275–281. doi: 10.6133/apjcn.202306_32(2).0010. PubMed DOI

Xu J., Chen X., Wang X., Zhu C., Hu Y., Yang X., Xu C., Shen X. Preoperative Hyponatremia And Hypocalcemia Predict Poor Prognosis In Elderly Gastric Cancer Patients. Cancer Manag. Res. 2019;11:8765–8780. doi: 10.2147/CMAR.S211603. PubMed DOI PMC

Serra F., Pedrazzoli P., Brugnatelli S., Pagani A., Corallo S., Rosti G., Caccialanza R., Viganò J., Carminati O. Nutritional Support Management in Resectable Gastric Cancer. Drugs Context. 2022;11:1–11. doi: 10.7573/dic.2022-5-1. PubMed DOI PMC

Ma K., Baloch Z., He T.-T., Xia X. Alcohol Consumption and Gastric Cancer Risk: A Meta-Analysis. Med. Sci. Monit. Int. Med. J. Exp. Clin. Res. 2017;23:238–246. doi: 10.12659/MSM.899423. PubMed DOI PMC

Smyth E.C., Capanu M., Janjigian Y.Y., Kelsen D.K., Coit D., Strong V.E., Shah M.A. Tobacco Use Is Associated with Increased Recurrence and Death from Gastric Cancer. Ann. Surg. Oncol. 2012;19:2088–2094. doi: 10.1245/s10434-012-2230-9. PubMed DOI

Bausys A., Luksta M., Kuliavas J., Anglickiene G., Maneikiene V., Gedvilaite L., Celutkiene J., Jamontaite I., Cirtautas A., Lenickiene S., et al. Personalized Trimodal Prehabilitation for Gastrectomy. Medicine. 2020;99:e20687. doi: 10.1097/MD.0000000000020687. PubMed DOI PMC

Sun Y., Tian Y., Li Z., Cao S., Liu X., Han H., Han L., Kong L., Zhang X., Liu F., et al. Multimodal Prehabilitation to Improve Functional Abilities and Reduce the Chronic Inflammatory Response of Frail Elderly Patients with Gastric Cancer: A Prospective Cohort Study. Eur. J. Surg. Oncol. J. Eur. Soc. Surg. Oncol. Br. Assoc. Surg. Oncol. 2024;51:109563. doi: 10.1016/j.ejso.2024.109563. PubMed DOI

Carrillo G.M., Santamaría N.P. Life after a Gastrectomy: Experience of Patients with Gastric Cancer. Enfermería Clínica Engl. Ed. 2019;29:27–33. doi: 10.1016/j.enfcli.2018.06.006. PubMed DOI

Hallowell N., Lawton J., Badger S., Richardson S., Hardwick R.H., Caldas C., Fitzgerald R.C. The Psychosocial Impact of Undergoing Prophylactic Total Gastrectomy (PTG) to Manage the Risk of Hereditary Diffuse Gastric Cancer (HDGC) J. Genet. Couns. 2017;26:752–762. doi: 10.1007/s10897-016-0045-8. PubMed DOI

Tew G.A., Ayyash R., Durrand J., Danjoux G.R. Clinical Guideline and Recommendations on Pre-Operative Exercise Training in Patients Awaiting Major Non-Cardiac Surgery. Anaesthesia. 2018;73:750–768. doi: 10.1111/anae.14177. PubMed DOI

Pouwels S., Stokmans R.A., Willigendael E.M., Nienhuijs S.W., Rosman C., van Ramshorst B., Teijink J.A.W. Preoperative Exercise Therapy for Elective Major Abdominal Surgery: A Systematic Review. Int. J. Surg. 2014;12:134–140. doi: 10.1016/j.ijsu.2013.11.018. PubMed DOI

Avinash S.H., Krishna H.M. The Impact of the Apfel Scoring System for Prophylaxis of Post-Operative Nausea and Vomiting: A Randomized Controlled Trial. J. Anaesthesiol. Clin. Pharmacol. 2023;39:463–467. doi: 10.4103/joacp.joacp_553_21. PubMed DOI PMC

Rosa F., Tortorelli A.P., Quero G., Galiandro F., Fiorillo C., Sollazzi L., Alfieri S. The Impact of Preoperative ASA-Physical Status on Postoperative Complications and Long-Term Survival Outcomes in Gastric Cancer Patients. Eur. Rev. Med. Pharmacol. Sci. 2019;23:7383–7390. doi: 10.26355/eurrev_201909_18846. PubMed DOI

Liu L.-B., Li J., Lai J.-X., Shi S. Harnessing Interventions during the Immediate Perioperative Period to Improve the Long-Term Survival of Patients Following Radical Gastrectomy. World J. Gastrointest. Surg. 2023;15:520–533. doi: 10.4240/wjgs.v15.i4.520. PubMed DOI PMC

Irino T., Matsuda S., Wada N., Kawakubo H., Kitagawa Y. Essential Updates 2019/2020: Perioperative and Surgical Management of Gastric Cancer. Ann. Gastroenterol. Surg. 2021;5:162–172. doi: 10.1002/ags3.12438. PubMed DOI PMC

Kulasegarah J., Lang E.E., Carolan E., Viani L., Gaffney R., Walsh R.M. Day of Surgery Admission—Is This Safe Practise? Ir. Med. J. 2008;101:218–219. PubMed

Dongare P.A., Bhaskar S.B., Harsoor S.S., Garg R., Kannan S., Goneppanavar U., Ali Z., Gopinath R., Sood J., Mani K., et al. Perioperative Fasting and Feeding in Adults, Obstetric, Paediatric and Bariatric Population: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J. Anaesth. 2020;64:556–584. doi: 10.4103/ija.IJA_735_20. PubMed DOI PMC

Faria M.S.M., de Aguilar-Nascimento J.E., Pimenta O.S., Alvarenga Jr L.C., Dock-Nascimento D.B., Slhessarenko N. Preoperative Fasting of 2 Hours Minimizes Insulin Resistance and Organic Response to Trauma After Video-Cholecystectomy: A Randomized, Controlled, Clinical Trial. World J. Surg. 2009;33:1158. doi: 10.1007/s00268-009-0010-x. PubMed DOI

Sukmono B., Hidayat J., Sugiarto A., Anggreni M. Preoperative Fasting of Eight Hours Provide Better Gastric Emptying: Ultrasound Assessment of Gastric Volume. Asian J. Anesthesiol. 2023;61 doi: 10.6859/aja.202309_61(3).0002. PubMed DOI

Bartlett M.A., Mauck K.F., Stephenson C.R., Ganesh R., Daniels P.R. Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin. Proc. 2020;95:2775–2798. doi: 10.1016/j.mayocp.2020.06.015. PubMed DOI

Kakkos S.K. Mechanical Thromboprophylaxis Is Effective in Reducing Postoperative Venous Thromboembolism. Br. J. Surg. 2022;109:667–668. doi: 10.1093/bjs/znac156. PubMed DOI

Yang D., Hou X., Fu H., Song W., Dong W., Wang H., Mao Y., Li M., Chen J., He Y. Gastric Residual Volume, Safety, and Effectiveness of Drinking 250 ML of Glucose Solution 2–3 Hours before Surgery in Gastric Cancer Patients: A Multicenter, Single-Blind, Randomized–Controlled Trial. Gastroenterol. Rep. 2024;12:goae077. doi: 10.1093/gastro/goae077. PubMed DOI PMC

Yagmurdur H., Gunal S., Yildiz H., Gulec H., Topkaya C. The Effects of Carbohydrate-Rich Drink on Perioperative Discomfort, Insulin Response and Arterial Pressure in Spinal Aesthesia. J. Res. Med. Sci. Off. J. Isfahan Univ. Med. Sci. 2011;16:1483–1489. PubMed PMC

Benington S. Preventing Aspiration and Regurgitation. Anaesth. Intensive Care Med. 2007;8:368–372. doi: 10.1016/j.mpaic.2007.07.011. DOI

Liu D.S., Stevens S.G., Watson D.I., Goh S.K., Muralidharan V., Wong E., Fong J., Wong D.J. Optimal Timing of Perioperative Chemoprophylaxis in Patients With High Thromboembolic Risk Undergoing Major Abdominal Surgery: A Multicenter Cohort Study. Ann. Surg. 2023;277:79–86. doi: 10.1097/SLA.0000000000005697. PubMed DOI

Cabral F., Ramos P., Monteiro C., Casaca R. Impact of Perioperative Chemotherapy on Postoperative Morbidity after Gastrectomy for Gastric Cancer. Cirugía Española. 2020;9:5–10. PubMed

Bucx M.J.L., Krijtenburg P., Kox M. Preoperative Use of Anxiolytic-Sedative Agents; Are We on the Right Track? J. Clin. Anesth. 2016;33:135–140. doi: 10.1016/j.jclinane.2016.03.025. PubMed DOI

Lefebvre A., Saliou P., Lucet J.C., Mimoz O., Keita-perse O., Boisrenoult P., Lepelletier D. Preoperative Hair Removal and Surgical Site Infections: Network Meta-Analysis of Randomized Controlled Trials. J. Hosp. Infect. 2015;91:100–108. doi: 10.1016/j.jhin.2015.06.020. PubMed DOI

Mahajan R.P. The WHO Surgical Checklist. Best Pract. Res. Clin. Anaesthesiol. 2011;25:161–168. doi: 10.1016/j.bpa.2011.02.002. PubMed DOI

Ball L., Lumb A.B., Pelosi P. Intraoperative Fraction of Inspired Oxygen: Bringing Back the Focus on Patient Outcome. Br. J. Anaesth. 2017;119:16–18. doi: 10.1093/bja/aex176. PubMed DOI

Maitra S., Kirtania J., Pal S., Bhattacharjee S., Layek A., Ray S. Intraoperative Blood Glucose Levels in Nondiabetic Patients Undergoing Elective Major Surgery under General Anaesthesia Receiving Different Crystalloid Solutions for Maintenance Fluid. Anesth. Essays Res. 2013;7:183–188. doi: 10.4103/0259-1162.118953. PubMed DOI PMC

Bruhn J., Myles P.S., Sneyd R., Struys M.M.R.F. Depth of Anaesthesia Monitoring: What’s Available, What’s Validated and What’s Next? Br. J. Anaesth. 2006;97:85–94. doi: 10.1093/bja/ael120. PubMed DOI

Anaesth A. Intraoperative Management and Hemodynamic Monitoring for Ma—Jor Abdominal Surgery: A Narrative Review. Acta Anæsthesiologica Belg. 2021;72:63–71.

Nicklas J.Y., Saugel B. Non-Invasive Hemodynamic Monitoring for Hemodynamic Management in Perioperative Medicine. Front. Med. 2017;4:209. doi: 10.3389/fmed.2017.00209. PubMed DOI PMC

Suh J., Lee S.-W. Preoperative Prediction of the Need for Arterial and Central Venous Catheterization Using Machine Learning Techniques. Sci. Rep. 2022;12:11948. doi: 10.1038/s41598-022-16144-z. PubMed DOI PMC

Werneburg G.T. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res. Rep. Urol. 2022;14:109–133. doi: 10.2147/RRU.S273663. PubMed DOI PMC

Lu X., Yu Y., Wang Y., Lyu Y. Effect of Propofol or Etomidate as General Anaesthesia Induction on Gastric Cancer: A Retrospective Cohort Study with 10 Years’ Follow-Up. Cancer Manag. Res. 2022;14:2399–2407. doi: 10.2147/CMAR.S361052. PubMed DOI PMC

Wetterslev J., Meyhoff C.S., Jørgensen L.N., Gluud C., Lindschou J., Rasmussen L.S. The Effects of High Perioperative Inspiratory Oxygen Fraction for Adult Surgical Patients. Cochrane Database Syst. Rev. 2015;2015:CD008884. doi: 10.1002/14651858.CD008884.pub2. PubMed DOI PMC

Zhu A.C.-C., Agarwala A., Bao X. Perioperative Fluid Management in the Enhanced Recovery after Surgery (ERAS) Pathway. Clin. Colon Rectal Surg. 2019;32:114–120. doi: 10.1055/s-0038-1676476. PubMed DOI PMC

Gao M., Chen M., Dai G., Zhu D., Cai Y. Clinical study: The impact of goal-directed fluid therapy on volume management during enhanced recovery after surgery in gastrointestinal procedures. Acta Biochim. Pol. 2024;71:12377. doi: 10.3389/abp.2024.12377. PubMed DOI PMC

Akyol D., Cukurova Z., Tulubas E.K., Yıldız G.O., Sabaz M.S. Goal-Directed Fluid Therapy in Gastrointestinal Cancer Surgery: A Prospective Randomized Study. J. Acute Dis. 2022;11:52–58. doi: 10.4103/2221-6189.342661. DOI

Harper C.M., McNicholas T., Gowrie-Mohan S. Maintaining Perioperative Normothermia. BMJ. 2003;326:721–722. doi: 10.1136/bmj.326.7392.721. PubMed DOI PMC

Liedl H.J.C., Lazenby K.A., Arimoto R.S., Singh A., Strelzow J.A. Normothermia to Decrease Surgical Site Infection Risk: Silver Bullet or Fool’s Gold? A Retrospective Cohort Study. J. Am. Acad. Orthop. Surg. Glob. Res. Rev. 2024;8:e23. doi: 10.5435/JAAOSGlobal-D-23-00227. PubMed DOI PMC

Shao L., Zheng H., Jia F., Wang H., Liu L., Sun Q., An M., Zhang X. Methods of Patient Warming during Abdominal Surgery. PLoS ONE. 2012;7:e39622. doi: 10.1371/journal.pone.0039622. PubMed DOI PMC

Huang Q., Wang F., Liang C., Huang Y., Zhao Y., Liu C., Lin C., Zhang L., Zhou S., Wang Q., et al. Fosaprepitant for Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Gastrointestinal Surgery: A Randomised Trial. Br. J. Anaesth. 2023;131:673–681. doi: 10.1016/j.bja.2023.06.029. PubMed DOI

Choy R., Pereira K., Silva S.G., Thomas N., Tola D.H. Use of Apfel Simplified Risk Score to Guide Postoperative Nausea and Vomiting Prophylaxis in Adult Patients Undergoing Same-Day Surgery. J. Perianesthesia Nurs. Off. J. Am. Soc. PeriAnesthesia Nurses. 2022;37:445–451. doi: 10.1016/j.jopan.2021.10.006. PubMed DOI

Article O., Xu L., Yao L., Qin J., Xu H. Efficacy of Multimodal Analgesia Based on the Concept of Enhanced Recovery after Surgery in Laparoscopic Radical Gastrectomy for Gastric Cancer. Pak. J. Med. Sci. 2024;40:2190–2195. PubMed PMC

Li K., Li L., Gao M., Zhu Z., Chen P., Yang L., Zhao G. Application of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block in Gastric Cancer Patients Undergoing Open Gastrectomy. Int. J. Clin. Exp. Med. 2015;8:13976–13982. PubMed PMC

Yoon S., Young G., Jihye S., Ho L., Lee J., Kong S.H., Kim W.H., Park D.J., Lee H.J., Yang H.K. Ultrasound—Guided Bilateral Subcostal Transversus Abdominis Plane Block in Gastric Cancer Patients Undergoing Laparoscopic Gastrectomy: A Randomised—Controlled Double—Blinded Study. Surg. Endosc. 2022;36:1044–1052. doi: 10.1007/s00464-021-08370-9. PubMed DOI

Rosen D.R., Wolfe R.C., Damle A., Atallah C., Chapman W.C., Jr., Vetter J.M., Mutch M.G., Hunt S.R., Glasgow S.C., Wise P.E., et al. Thoracic Epidural Analgesia: Does It Enhance Recovery? Dis. Colon Rectum. 2019;61:1403–1409. doi: 10.1097/DCR.0000000000001226. PubMed DOI PMC

Hakkenbrak N.A.G., Jansma E.P., van der Wielen N., van der Peet D.L., Straatman J. Laparoscopic versus Open Distal Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis. Surgery. 2022;171:1552–1561. doi: 10.1016/j.surg.2021.11.035. PubMed DOI

Wang Z., Chen J., Su K., Dong Z., Wang Z., Chen J., Su K., Dong Z. Abdominal Drainage versus No Drainage Post-Gastrectomy for Gastric Cancer. Cochrane Database Syst. Rev. 2015;2015:CD008788. doi: 10.1002/14651858.CD008788.pub3. PubMed DOI PMC

Reasbeck P. Routine Use of Nasogastric Drainage Tubes. Ann. R. Coll. Surg. Engl. 2019;101:537. doi: 10.1308/rcsann.2016.0155. PubMed DOI PMC

Kurz A., Sessler D.I., Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N. Engl. J. Med. 1996;334:1209–1216. doi: 10.1056/NEJM199605093341901. PubMed DOI

Purwadadi I.K., Luh N., Inca P., Agustini B., Nuryanto K. The Effectiveness of Blanket Warmer, Warm Intravenous Fluids, and Operating Room Temperature Modification in Preventing Perioperative Hypothermia. Jurnal Kesehat. 2024;15:134–143. doi: 10.26630/jk.v15i1.4043. DOI

Kim S.Y., Kim N.K., Baik S.H., Min B.S., Hur H., Lee J., Noh H.-Y., Lee J.H., Koo B.-N. Effects of Postoperative Pain Management on Immune Function After Laparoscopic Resection of Colorectal Cancer: A Randomized Study. Medicine. 2016;95:e3602. doi: 10.1097/MD.0000000000003602. PubMed DOI PMC

van der Veen A., Ramaekers M., Marsman M., Brenkman H.J.F., Seesing M.F.J., Luyer M.D.P., Nieuwenhuijzen G.A.P., Stoot J.H.M.B., Tegels J.J.W., Wijnhoven B.P.L., et al. Pain and Opioid Consumption After Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Secondary Analysis of a Multicenter Randomized Clinical Trial (LOGICA-Trial) J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2023;27:2057–2067. doi: 10.1007/s11605-023-05728-3. PubMed DOI PMC

Jin L., Guo K. Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study [Response to Letter] Drug Des. Devel. Ther. 2023;17:2457–2460. doi: 10.2147/DDDT.S434637. PubMed DOI PMC

Jo D.H., Jeong O., Sun J.W., Jeong M.R., Ryu S.Y., Park Y.K. Feasibility Study of Early Oral Intake after Gastrectomy for Gastric Carcinoma. J. Gastric Cancer. 2011;11:101–108. doi: 10.5230/jgc.2011.11.2.101. PubMed DOI PMC

Jønsson L.R., Foss N.B., Orbæk J., Lauritsen M.L., Sejrsen H.N., Kristensen M.T. Early Intensive Mobilization after Acute High-Risk Abdominal Surgery: A Nonrandomized Prospective Feasibility Trial. Can. J. Surg. 2023;66:E236–E245. doi: 10.1503/cjs.008722. PubMed DOI PMC

Porserud A., Aly M., Nygren-Bonnier M., Hagströmer M. Association between Early Mobilisation after Abdominal Cancer Surgery and Postoperative Complications. Eur. J. Surg. Oncol. 2023;49:106943. doi: 10.1016/j.ejso.2023.05.018. PubMed DOI

Tetzlaff E.D., Cheng J.D., Ajani J.A. Thromboembolism in Gastrointestinal Cancers. Gastrointest. Cancer Res. 2008;2:267–272. PubMed PMC

Song J., Xuan L., Wu W., Huang J., Zhong M. Low Molecular Weight Heparin Once versus Twice for Thromboprophylaxis Following Esophagectomy: A Randomised, Double-Blind and Placebo-Controlled Trial. J. Thorac. Dis. 2015;7:1158–1164. doi: 10.3978/j.issn.2072-1439.2015.06.15. PubMed DOI PMC

Obrink E., Jildenstål P., Oddby E., Jakobsson J.G. Post-Operative Nausea and Vomiting: Update on Predicting the Probability and Ways to Minimize Its Occurrence, with Focus on Ambulatory Surgery. Int. J. Surg. 2015;15:100–106. doi: 10.1016/j.ijsu.2015.01.024. PubMed DOI

Hur H., Kim S.G., Shim J.H., Song K.Y., Kim W., Park C.H., Jeon H.M. Effect of Early Oral Feeding after Gastric Cancer Surgery: A Result of Randomized Clinical Trial. Surgery. 2011;149:561–568. doi: 10.1016/j.surg.2010.10.003. PubMed DOI

Tegels J.J.W., De Maat M.F.G., Hulsewé K.W.E., Hoofwijk A.G.M., Stoot J.H.M.B. Improving the Outcomes in Gastric Cancer Surgery. World J. Gastroenterol. 2014;20:13692–13704. doi: 10.3748/wjg.v20.i38.13692. PubMed DOI PMC

Willner A., Teske C., Hackert T., Welsch T. Effects of Early Postoperative Mobilization Following Gastrointestinal Surgery: Systematic Review and Meta-Analysis. BJS Open. 2023;7:zrad102. doi: 10.1093/bjsopen/zrad102. PubMed DOI PMC

Gedda C., Nygren J., Garpenbeck A., Hoffström L., Thorell A., Soop M. Multimodal Analgesia Bundle and Postoperative Opioid Use Among Patients Undergoing Colorectal Surgery. JAMA Netw. Open. 2023;6:e2332408. doi: 10.1001/jamanetworkopen.2023.32408. PubMed DOI PMC

Rourke K.O., Morrison B., Sen S., Jones C. Fluid Management for Enhanced Recovery Surgery. Dig. Med. Res. 2019;2:37. doi: 10.21037/dmr.2019.09.05. DOI

Meillat H., Magallon C., Brun C., Chaisemartin C.D., Moureau-zabotto L. Coloproctology Systematic Early Urinary Catheter Removal Integrated in the Full Enhanced Recovery After Surgery (ERAS) Protocol After Laparoscopic Mid to Lower Rectal Cancer Excision: A Feasibility Study Coloproctology. Ann. Coloproctology. 2021;37:204–211. doi: 10.3393/ac.2020.05.22. PubMed DOI PMC

Zhou L., Li Y., Ni Y., Liu C. Analysis of postoperative pulmonary complications after gastrectomy for gastric cancer: Development and validation of a nomogram. Front. Surg. 2023;10:1308591. doi: 10.3389/fsurg.2023.1308591. PubMed DOI PMC

Parthasarathy S., Ravishankar M., Aravindan U. Total Radical Gastrectomy under Continuous Thoracic Epidural Anaesthesia. Indian J. Anaesth. 2010;54:358–359. doi: 10.4103/0019-5049.68385. PubMed DOI PMC

Nakagawa M., Tokunaga M., Aburatani T., Sato Y., Matsuyama T., Nakajima Y., Kinugasa Y. Feasibility and Safety of Early Oral Intake and Discharge After Total or Proximal Gastrectomy: An Analysis of Consecutive Cases Without Exclusion Criteria. Ann. Surg. Oncol. 2020;27:812–821. doi: 10.1245/s10434-019-08072-6. PubMed DOI

Cananzi F.C.M., Biondi A., Agnes A., Ruspi L., Sicoli F., De Pascale S., Fumagalli U.R., D’Ugo D., Quagliuolo V., Persiani R. Optimal Predictors of Postoperative Complications After Gastrectomy: Results from the Procalcitonin and C-Reactive Protein for the Early Diagnosis of Anastomotic Leakage in Esophagogastric Surgery (PEDALES) Study. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2023;27:478–488. doi: 10.1007/s11605-022-05547-y. PubMed DOI

Guner A., Kim K.Y., Park S.H., Cho M., Kim Y.M., Hyung W.J., Kim H.-I. Safe Discharge Criteria After Curative Gastrectomy for Gastric Cancer. J. Gastric Cancer. 2022;22:395–407. doi: 10.5230/jgc.2022.22.e32. PubMed DOI PMC

Choi Y.Y. Decision for Safe Discharge After Gastric Cancer Surgery: The Finale of Enhanced Recovery After Surgery Program. J. Gastric Cancer. 2022;22:261–263. doi: 10.5230/jgc.2022.22.e34. PubMed DOI PMC

Kubota T., Shoda K., Konishi H., Okamoto K., Otsuji E. Nutrition Update in Gastric Cancer Surgery. Ann. Gastroenterol. Surg. 2020;4:360–368. doi: 10.1002/ags3.12351. PubMed DOI PMC

Karanicolas P.J., Graham D., Gönen M., Strong V.E., Brennan M.F., Coit D.G. Quality of Life after Gastrectomy for Adenocarcinoma: A Prospective Cohort Study. Ann. Surg. 2013;257:1039–1046. doi: 10.1097/SLA.0b013e31828c4a19. PubMed DOI PMC

Mithany R.H., Daniel N., Shahid M.H., Aslam S., Abdelmaseeh M., Gerges F., Gill M.U., Abdallah S.B., Hannan A., Saeed M.T., et al. Revolutionizing Surgical Care: The Power of Enhanced Recovery After Surgery (ERAS) Cureus. 2023;15:e48795. doi: 10.7759/cureus.48795. PubMed DOI PMC

Kehlet H. Enhanced Recovery After Surgery (ERAS): Good for Now, but What about the Future? Can. J. Anaesth. 2014;62:99–104. doi: 10.1007/s12630-014-0261-3. PubMed DOI

Turaga A.H. Enhanced Recovery After Surgery (ERAS) Protocols for Improving Outcomes for Patients Undergoing Major Colorectal Surgery. Cureus. 2023;15:e41755. doi: 10.7759/cureus.41755. PubMed DOI PMC

Hu Y., Hsu A.W., Strong V.E. Enhanced Recovery After Major Gastrectomy for Cancer. Ann. Surg. Oncol. 2022;28:6947–6954. doi: 10.1245/s10434-021-09906-y. PubMed DOI PMC

Jeong O., Jang A., Jung M.R., Kang J.H., Ryu S.Y. The Benefits of Enhanced Recovery after Surgery for Gastric Cancer: A Large before-and-after Propensity Score Matching Study. Clin. Nutr. 2021;40:2162–2168. doi: 10.1016/j.clnu.2020.09.042. PubMed DOI

Sugisawa N., Tokunaga M., Makuuchi R., Miki Y., Tanizawa Y., Bando E., Kawamura T., Terashima M. A Phase II Study of an Enhanced Recovery after Surgery Protocol in Gastric Cancer Surgery. Gastric Cancer Off. J. Int. Gastric Cancer Assoc. Jpn. Gastric Cancer Assoc. 2016;19:961–967. doi: 10.1007/s10120-015-0528-6. PubMed DOI

Liu G., Cao S., Liu X., Tian Y., Li Z., Sun Y., Zhong H., Wang K., Zhou Y. Short- and Long-Term Outcomes Following Perioperative ERAS Management in Patients Undergoing Minimally Invasive Radical Gastrectomy after Neoadjuvant Chemotherapy: A Single-Center Retrospective Propensity Score Matching Study. Eur. J. Surg. Oncol. 2025;51:109459. doi: 10.1016/j.ejso.2024.109459. PubMed DOI

Jeong O., Jung M.R. Enhanced Recovery After Surgery for Gastrectomy. Foregut Surg. 2023;3:65–74. doi: 10.51666/fs.2023.3.e7. DOI

Davis M.J., Luu B.C., Raj S., Abu-Ghname A., Buchanan E.P. Multidisciplinary Care in Surgery: Are Team-Based Interventions Cost-Effective? Surgeon. 2021;19:49–60. doi: 10.1016/j.surge.2020.02.005. PubMed DOI

Özçelik M. Implementation of ERAS Protocols: In Theory and Practice. Turkish J. Anaesthesiol. Reanim. 2024;52:163–168. doi: 10.4274/TJAR.2024.241723. PubMed DOI PMC

Wee I.J.Y., Syn N.L.-X., Shabbir A., Kim G., So J.B.Y. Enhanced Recovery versus Conventional Care in Gastric Cancer Surgery: A Meta-Analysis of Randomized and Non-Randomized Controlled Trials. Gastric Cancer Off. J. Int. Gastric Cancer Assoc. Jpn. Gastric Cancer Assoc. 2019;22:423–434. doi: 10.1007/s10120-019-00937-9. PubMed DOI

Lombardi P.M., Mazzola M., Giani A., Baleri S., Maspero M., De Martini P., Gualtierotti M., Ferrari G. ERAS Pathway for Gastric Cancer Surgery: Adherence, Outcomes and Prognostic Factors for Compliance in a Western Centre. Updates Surg. 2021;73:1857–1865. doi: 10.1007/s13304-021-01093-5. PubMed DOI

Mariette C. Role of the Nutritional Support in the ERAS Programme. J. Visc. Surg. 2015;152:S18–S20. doi: 10.1016/S1878-7886(15)30006-0. PubMed DOI

Gillis C., Ljungqvist O., Carli F. Prehabilitation, Enhanced Recovery after Surgery, or Both? A Narrative Review. Br. J. Anaesth. 2022;128:434–448. doi: 10.1016/j.bja.2021.12.007. PubMed DOI

Hart N.H., Crawford-Williams F., Crichton M., Yee J., Smith T.J., Koczwara B., Fitch M.I., Crawford G.B., Mukhopadhyay S., Mahony J., et al. Unmet Supportive Care Needs of People with Advanced Cancer and Their Caregivers: A Systematic Scoping Review. Crit. Rev. Oncol. Hematol. 2022;176:103728. doi: 10.1016/j.critrevonc.2022.103728. PubMed DOI

Recommendations for Perioperative Care in Liver Resection: The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol