Table 1 Multimodal protocols for elective fast-track gastric cancer surgery**

Preoperative phase

Scheduling of operation

Information about FT and informed consent

Pre-assessment for risk adjustment

Last meal 6 h before operation

Last clear drink (10% Glucose 500 ml) 2 h before operation

Intraoperative phase

Prophylactic antibiotic (cefoperazone 2 g)

Placement of thoracic epidural catheter (T8-T10) followed by continuous EDA until POD3

Combined with general anesthesia

Restricted intraoperative fluid therapy to 500 cc colloid and 1,500 cc crystalloid infusion

Use of vasopressor drugs as 1st choice for management of mean blood pressure drop >20% of baseline

Prophylactic use of odansetron to prevent PONV

Forced body heating

No standard use of abdominal drains and nasogastric tube

Intradermic suture with absorbable suture

Postoperative phase

Admit to regular nursing floor via ICU (POD 1)

Continuous EDA (3d) with tramadol 500 mg po 12 h

Oral intake of clear liquids (100-150 ml Glucose) 2 h after extubation, followed by stepwise plan from warm clear water to carbohydrate drink to TPF, then to semi-fluids to normal food.

Adhere to a regimen of frequent small meals.

Restricted IV fluid administration until complete oral intake

Enforced mobilization from the day of surgery following a well-defined nursing care program

Removal of bladder catheter in POD1 morning

Outpatient clinic; discuss result of histological examination, plan adjuvant therapy if needed (POD 10)