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World Journal of Surgery

, Volume 36, Issue 2, pp 407–414 | Cite as

Enhanced Recovery After Surgery (ERAS) Program Attenuates Stress and Accelerates Recovery in Patients After Radical Resection for Colorectal Cancer: A Prospective Randomized Controlled Trial

  • Li Ren
  • Dexiang Zhu
  • Ye Wei
  • Xiangou Pan
  • Li Liang
  • Jianmin Xu
  • Yunshi Zhong
  • Zhanggang Xue
  • Ling Jin
  • Shaokang Zhan
  • Weixin Niu
  • Xinyu Qin
  • Zhaohan Wu
  • Zhaoguang Wu
Article

Abstract

Background

The aim of this trial was to compare the Enhanced Recovery After Surgery (ERAS) program with conventional perioperative management in patients who underwent radical resection for colorectal cancer.

Methods

A combination of evidence-based and consensus methodology was used to develop the ERAS protocol. Five hundred ninety-seven consecutive patients who underwent elective colorectal resection were randomized to either the ERAS (n = 299) or the control group (n = 298). Outcomes relating to nutrition and metabolism index, stress index, and recovery index were measured and recorded.

Results

Demographic and operative data were similar between the two groups. Patients in the ERAS group showed improved nutritional status when compared with those of the control group. On postoperative day (POD) 1, the HOMA-IR (insulin resistance index) of the ERAS group was lower than that of the control group (p < 0.001). The cortisol level of the control group was elevated on both POD 1 (p = 0.007) and POD 5 (p = 0.002) compared to the preoperative level. However, the cortisol level of the ERAS group was not increased until POD 5 (p = 0.001). Reduced levels of TNF-α, IL-1β, IL-6, and IFN-γ in the ERAS group indicated less postoperative stress responses. In addition, ERAS was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay (p < 0.001) and expense (p < 0.001) for the ERAS group were reduced in comparison to the controls. Twenty-eight cases in the control group and twenty-nine in the ERAS group suffered complications, which was not significantly different.

Conclusion

The ERAS protocol attenuates the surgical stress response and accelerates postoperative recovery without compromising patient safety.

Keywords

Stress Index Mechanical Bowel Preparation Metabolism Index Traditional Chinese Herbal Medicine Cerebrovascular Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This project was sponsored by the Key Clinical Project from the Ministry of Health of China (2010–2012), the Surface Project from the Biomedical Department of Shanghai Science and Technology Commission in 2009 (09411967100), the National Natural Science Foundation of China in 2009 (30973416), and the Key Project of Shanghai Science and Technology Commission in 2008 (08431910200).

Supplementary material

268_2011_1348_MOESM1_ESM.doc (218 kb)
Supplementary material 1 (DOC 218 kb)
268_2011_1348_MOESM2_ESM.doc (234 kb)
Supplementary material 2 (DOC 234 kb)
268_2011_1348_MOESM3_ESM.doc (36 kb)
Supplementary material 3 (DOC 36 kb)

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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Li Ren
    • 1
    • 2
    • 3
    • 4
  • Dexiang Zhu
    • 1
    • 2
    • 3
    • 4
  • Ye Wei
    • 1
    • 2
    • 3
    • 4
  • Xiangou Pan
    • 1
    • 2
    • 3
    • 4
  • Li Liang
    • 1
    • 2
    • 3
    • 4
  • Jianmin Xu
    • 1
    • 2
    • 3
    • 4
  • Yunshi Zhong
    • 1
    • 2
    • 3
    • 4
  • Zhanggang Xue
    • 5
  • Ling Jin
    • 5
  • Shaokang Zhan
    • 6
  • Weixin Niu
    • 1
    • 2
    • 3
    • 4
  • Xinyu Qin
    • 1
    • 2
    • 3
    • 4
  • Zhaohan Wu
    • 1
    • 2
    • 3
    • 4
  • Zhaoguang Wu
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of General Surgery, Zhongshan HospitalFudan University Medical CenterShanghaiPeople’s Republic of China
  2. 2.Colorectal Cancer Research CenterFudan UniversityShanghaiPeople’s Republic of China
  3. 3.Institute of General SurgeryFudan UniversityShanghaiPeople’s Republic of China
  4. 4.Department of SurgeryShanghai Medical College, Fudan UniversityShanghaiPeople’s Republic of China
  5. 5.Department of Anesthesia, Zhongshan HospitalFudan UniversityShanghaiPeople’s Republic of China
  6. 6.Department of Statistics, School of Public HealthFudan UniversityShanghaiPeople’s Republic of China

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