Abstract
Purpose
The aim of this multi-institutional study was to prospectively evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) protocol for colonic surgery.
Methods
The subjects of this study were 320 patients with an American Society of Anesthesiologists (ASA) grade I or II physical status. Patients underwent elective open or laparoscopic colonic resection or high anterior resection between April 2011 and January 2014 at one of six institutions. Three hospitals implemented an ERAS protocol (n = 159), and three administered conventional care (n = 161). The primary outcome measure was the surgical complication rate.
Results
Most operations, irrespective of group, were performed laparoscopically. The incidence of a surgical complication was 17.0 % in the ERAS group vs. 16.1 % in the conventional group (P = 0.842), in which several non-surgical complications also arose. Oral food intake was implemented earlier for the ERAS group vs. the conventional group, after a median (range) of 1 (1–31) vs. 3 (1–9) days for the ERAS vs. conventional care groups, respectively (P < 0.001). The median length of postoperative hospital stay was reduced by 5.5 days for the ERAS group, being 8.5 (5–41) vs. 14 (7–56) days for the ERAS vs. conventional care groups, respectively (P < 0.001).
Conclusion
This multi-institutional controlled study clearly demonstrated that an ERAS protocol was efficient, without increasing the complication risk.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Marusch F, Koch A, Schmidt U, Zippel R, Lehmann M, Czarnetzki HD, et al. Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study. Int J Colorectal Dis. 2001;16:362–9.
Marusch F, Koch A, Schmidt U, Zippel R, Gastmeier J, Ludwig K, et al. Impact of age on the short-term postoperative outcome of patients undergoing surgery for colorectal carcinoma. Int J Colorectal Dis. 2002;17(3):177–84.
Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Asahara T, Nomoto K, et al. Efficacy of perioperative synbiotics treatment for the prevention of surgical site infection after laparoscopic colorectal surgery: a randomized controlled trial. Surg Today. 2016;46:479–90.
Fujita F, Torashima Y, Kuroki T, Eguchi S. Risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surg Today. 2014;44(9):1595–602.
Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, Enhanced Recovery After Surgery (ERAS) Group, et al. Consensus review of optimal perioperative care in colorectal surgery. Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144:961–9.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(668–68):5.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531–41.
Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;(2):CD007635. doi:10.1002/14651858.CD007635.pub2.
Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery. a randomized clinical trial (LAFA-study). Ann Surg. 2011;254:868–75.
Kennedy RH, Francis EA, Wharton R, Blazeby JM, Quirke P, West NP, et al. Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol. 2014;32(17):1804–11.
Shigeta K, Baba H, Yamafuji K, Asami A, Takeshima K, Nagasaki K, et al. Effects of laparoscopic surgery on the patterns of death in elderly colorectal cancer patients: competing risk analysis compared with open surgery. Surg Today. 2016;46:422–9.
Kisialeuski M, Pędziwiatr M, Matłok M, Major P, Migaczewski M, Kołodziej D, et al. Enhanced recovery after colorectal surgery in elderly patients. Videosurg Miniinv. 2015;10:30–6.
ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection. Ann Surg. 2015 (Epub ahead of print).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None of the authors has any conflict of interest to report.
Rights and permissions
About this article
Cite this article
Ota, H., Ikenaga, M., Hasegawa, J. et al. Safety and efficacy of an “enhanced recovery after surgery” protocol for patients undergoing colon cancer surgery: a multi-institutional controlled study. Surg Today 47, 668–675 (2017). https://doi.org/10.1007/s00595-016-1423-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-016-1423-4