Feasibility of a tubeless enhanced recovery strategy in non-high-risk patients undergoing laparoscopy-assisted gastrectomy for gastric cancer

Background: Although nasogastric decompression, nasojejunal feeding, and abdominal drainage tubes are not routinely recommended in Enhanced Recovery After Surgery (ERAS) guidelines for gastrectomy, evidence regarding the avoidance of any inserted tubes after laparoscopic gastrectomy remains limited. This study aimed to evaluate the short-term feasibility and clinical outcomes of an ERAS-tubeless protocol in gastric cancer patients undergoing non-high-risk laparoscopy-assisted gastrectomy. Methods: At a high-volume center, eligible patients of gastric cancer (cT1-4N0-3M0) who lacked protocol-defined high-risk features were enrolled in this prospective non-randomized controlled study. Patients were allocated to either the ERAS-tubeless group or the ERAS-tube group at a predefined 1:1 ratio according to a team-level allocation protocol. All patients underwent laparoscopy-assisted gastrectomy following strict and consistent quality control standards and received distinct ERAS-based postoperative tube-management strategies. The primary outcome was postoperative hospital stay, and secondary outcomes included postoperative quality of life scores and the incidence of complications. Results: Between March 2023 and September 2024, 220 patients were allocated, and 205 were included in the per-protocol population after post-allocation exclusions. The ERAS-tubeless group had a shorter mean postoperative hospital stay (6.0 vs. 7.3 days; P < 0.001). After Benjamini–Hochberg adjustment for multiple comparisons, QoR-15 scores remained significantly higher on postoperative days 1 and 3. For the EORTC QLQ-C30, significant between-group differences persisted in global health and QoL, emotional functioning, and social functioning domains. No increase in the incidence of early postoperative complications was observed; however, the study was underpowered to exclude rare but serious adverse events. Conclusions: In non-high-risk patients with gastric cancer, implementation of the ERAS-tubeless strategy following laparoscopy-assisted gastrectomy under a rigorous surgical quality control system can facilitate postoperative recovery, enhance patient experience, and not increase the risk of early postoperative complications, which warrants further validation.