The impact of enhanced recovery after surgery on postoperative recovery in patients with distal gastric cancer combined with diabetes

To explore the effects of enhanced recovery after surgery (ERAS) on postoperative gastrointestinal function recovery, inflammatory response, and blood sugar-related indicators in patients with diabetes combined with distal gastric cancer. This study used a prospective, non-blinded, randomized controlled clinical intervention approach. We selected 80 patients with diabetes combined with distal gastric cancer who underwent distal gastrectomy in our hospital’s gastrointestinal surgery department from January 2022 to December 2024. They were randomly divided into a control group and an ERAS group in a 1:1 ratio, with 40 cases in each group. The control group received routine perioperative care, while the ERAS group received ERAS perioperative care. We compared postoperative time to first flatus, time to first bowel movement, length of hospital stay, occurrence of complications, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and inflammatory markers between the two groups. Quantitative data were analyzed using t-tests, and categorical data were analyzed using χ² tests or Fisher’s exact test. The ERAS group had shorter postoperative time to first flatus, first defecation, and hospital stay compared to the control group, and these differences were statistically significant (t = 3.892, 3.046, 2.273, P < 0.001, P = 0.003, P = 0.026). On postoperative day 1, the ERAS group had lower fasting blood glucose and fasting insulin than the control group (t = 4.081, 5.855, both P < 0.001), and their HOMA-IR was lower than the control group but the difference was not statistically significant (t = 1.709, P = 0.091). On postoperative day 3, there were no significant differences between the two groups in fasting blood glucose, fasting insulin, or HOMA-IR ( P > 0.05). On postoperative day 5, the ERAS group had lower levels of C-reactive protein, interleukin-6, serum amyloid A, and tumor necrosis factor-α compared to the control group (t = 9.536, 12.047, 10.049, 6.369, all P < 0.01). There was no significant difference in the incidence of complications between the two groups (χ2 = 1.090, P = 1.000). ERAS perioperative management can help patients with diabetes and distal gastric cancer recover gastrointestinal function after surgery, reduce postoperative inflammation, and improve early postoperative blood glucose and insulin levels. No statistically significant difference in postoperative complications was observed between the two groups.