Feasibility of Enhanced Recovery After Surgery Protocol in Gallbladder Cancer

Abstract

Enhanced recovery after surgery (ERAS) protocol is a multimodal, multidisciplinary, and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the compliance with ERAS protocol and its effect on postoperative outcomes in Gallbladder Cancer (GBC) patients. A total of 45 patients with suspected or proven GBC who underwent curative intent surgery (radical cholecystectomy- RC ± additional procedures) between January 2021 and January 2023 were included in the study. As per the institute ERAS protocol, nasogastric tube (NGT) was removed on postoperative day (POD) 0/1 if output was less than 100 mL and clear liquids were allowed; ambulation at least 3 times out of bed on POD1; semisolid diet by POD3; urinary catheter and epidural catheter were removed by POD3; normal diet was allowed on POD5. Early removal of abdominal drain was encouraged as per the discretion of the surgeon. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free, and full ambulatory. NGT was removed on POD 0/1 in 31(72.1%) patients, abdominal drain removed by POD3 in 8 (18.2%), and 32 (71.1%) patients were discharged by POD6. There was no 30-day postoperative mortality. Complications were seen in 12 (26.7%) patients, of whom 2 (4.4%) were major and rest minor; all were conservatively managed. Three (6.67%) patients were readmitted. A compliance score of > 66.67 was identified as a significant predictor of the absence of complications. A significant inverse association was found between diabetes mellitus (p = 0.009), additional procedures (p = 0.023), and operative time (p = 0.039) with compliance. The length of hospital stay (LOS) was significantly less in patients with good compliance (p < 0.0001). ERAS protocol can be safely followed in the perioperative care of patients with GBC. ERAS decreases LOS and postoperative complications. © The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2025.