LAUSR

To the Editor, We have read with interest the article published by Roh Chul Kyu. Although we believe it is a very interesting topic and let us know the importance of enhanced recovery after surgery, we would like to offer the following points for your consideration. First, there was no statistically significant difference between the surgical methods of the ERAS CP group and the Conventional CP group (ERAS CP: Laparoscopy 95, Robot 22; Conventional CP: Laparoscopy 111, Robot 26; P= .237), however, the difference in surgical time between the two groups of patients was statistically significant (135.1 ± 32.3 vs 164.9 ± 47.5, P< .001), and whether this could explain that the surgical operators in the two groups were not one person or one team. As we all know, laparoscopic surgery has a long learning curve, and inexperienced operators often bring greater trauma to patients. which increases postoperative complications and postoperative hospitalization. Authors should be clear about this and avoid false‐positive results. Second, the differences between pT classification, pN classification, extent of lymphadenectomy and estimated blood loss in the ERAS CP group and the Conventional CP group were statistically significant (P < .05). However, the difference of tumor stage, the scope of lymph node dissection, and the amount of bleeding during operation will affect the length of stay and the cost of hospitalization. Therefore, the conclusion of this study needs to exclude whether it is caused by ERAS CP or by the patient's own differences. Third, clinical pathway for enhanced recovery after surgery in gastric cancer patients needs to be further detailed, For example, preoperative education should be increased in day before surgery, which can reduce patient anxiety; the use of as few opioids as possible should be increased in day of surgery, which is conducive to the recovery of intestinal function after surgery.