Gastric cancer is one of the most common malignant tumors in China, and Surgery is the only radical approach. As aging has become a social problem, the number of elderly patients with gastric cancer is also increasing. However, due to cardiopulmonary complications increasing, physical function declining, relatively low immunity, and malnutrition of elderly patients, postoperative complications will be increased and recovery will be slow after abdominal surgery [6, 7]. Therefore, it is a hot topic in clinical research on how to promote the rapid recovery of laparoscopic radical gastrectomy cancer for elderly patients.
ERAS was first proposed by Kehlet, a Danish scholar. It adopts a series of evidence-based medical management measures to reduce the patient's surgical stress and postoperative complications effectively, and promote patient’s rehabilitation. The optimization management measures include preoperative education, intraoperative warming, early post-extubation, early getting out of bed, early eating after surgery and so on . EARS is widely promoted and proves to have following characteristics：shorten postoperative hospital stay after surgery, reduce postoperative complications, ease pain and improve postoperative recovery [8, 9]. In this study, the time for the first time to get out of bed in the accelerated rehabilitation group, postoperative liquid food intake time, and the anal recovery exhaust time were significantly lower than those in the control group; the postoperative hospital stay was also significantly lower than that in the control group, which is consistent with the results reported in the literature [4, 10].
For elderly patients, most surgeons prefer to adopt conservative treatments during perioperative management. In order to prevent aspiration during anesthesia and surgery, patients require long time fasting before surgery. However, some studies show that long period fasting will cause hunger, anxiety and energy consumption of the body, which easily disorders patient's internal environment, reduces their stress ability, and decreases resistance and immunity. Traditionally, bowel preparation is required before abdominal surgery. But there are reports showing that bowel preparation may increase risk of surgical complications, such as abdominal adhesions, flora imbalance, fluid and electrolyte disorders, infection risk increasing, anastomotic leak and so on . Compared with ERAS group and control group, there were no statistically significant differences in postoperative complication rate (15.1% vs 21.3%,P=0.38), anastomotic leak rate, infection risk and Duodenal stump leakage (5.5% vs 2.1% ,P=0.66; 5.5% vs 4.3% ,P=0.89; 2.1% vs 2.7%, P=0.69), which is similar to Tweed’s  research. The main reason should be ERAS group does not perform bowel preparation before surgery, which ensures the normal intestinal flora and reduces the postoperative inflammatory response. The ERAS group also has early postoperative intake, which reduces digestive juice loss, avoids fluid and electrolyte disorders, and enhances the intestinal function recovery. In traditional concept, gastrointestinal tract will be paralyzed after surgery, so indwelling gastric tube should be placed to observe and reduce postoperative complications. But most of elderly patients have cardiopulmonary complications, in that case indwelling gastric tube may cause sputum blockage and lung infection. Besides, indwelling gastric tube restricts patient’s activity, and then increases the risk of deep venous thrombosis. In this study, the incidence of lung infection of ERAS group is obviously lower than Control group (1.4% vs 10.6%, P=0.03). Non-indwelling gastric tube for ERAS group is one of the reasons, and the other one is the group will organize a series of activities for elderly patients, like ERAS conception propaganda before surgery, respiratory function exercise, routine atomization inhalation, back patting after operation, encouraging patients to get out of bed earlier, cough and expectoration.
In summary, the application of ERAS concepts and measures during the perioperative period of laparoscopic radical gastrectomy cancer for patients aged ≥70 years can not only promote rapid postoperative recovery, reduce postoperative hospital stay, but also reduce postoperative incidence of lung infection. The concept and measures are worthy of application and promotion in elderly patients undergoing laparoscopic radical gastrectomy cancer. Of course, this study is a retrospective study. It is inevitable that there is selection bias. The analgesic effect of postoperative patients and the improvement of anesthesia during the operation have not been studied. These will be the directions for further research.