Impact of enhanced recovery after surgery protocol on postoperative complications and hospital stay following laparoscopic distal gastrectomy for gastric cancer

Laparoscopic distal gastrectomy is a standard surgical treatment for gastric cancer, but traditional postoperative care often results in prolonged recovery and hospital stays. Enhanced Recovery After Surgery (ERAS) protocols shown improved postoperative outcomes in various surgical disciplines, but their effect on gastric cancer surgery outcomes requires further investigation. This retrospective before–after study included 182 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The control group (n = 85; January 2021–December 2022) received standard perioperative care, while the ERAS group (n = 97; January 2023–June 2025) followed an enhanced recovery protocol. Primary outcomes were postoperative length of stay (LOS) and overall 30-day complication rate. The ERAS group showed significantly shorter times to first flatus (38.45 vs. 52.67 h, P < 0.001) and reduced LOS (6.23 vs. 9.45 d, mean difference − 3.28 d, P < 0.001). VAS pain scores were significantly lower in the ERAS group at 24 and 48 h postoperatively (P < 0.001). Multivariable regression confirmed ERAS as an independent predictor of reduced LOS (B = − 3.254; P < 0.001). Overall complications were numerically lower (10.31% vs. 18.82%; adjusted OR 0.473; P = 0.093) but did not reach significance (achieved power 37.4%). Patient satisfaction (PSQ-18) was significantly higher in the ERAS group (P < 0.001). The ERAS protocol was associated with significantly reduced LOS, improved pain management, and enhanced patient satisfaction following laparoscopic distal gastrectomy for gastric cancer. These findings suggest the adoption of ERAS pathways in gastric cancer surgery to optimize recovery outcomes.