Advertisement

World Journal of Surgery

, Volume 40, Issue 10, pp 2519–2527 | Cite as

Enhanced Recovery Pathway for Right and Left Colectomy: Comparison of Functional Recovery

  • Anne Kummer
  • Juliette Slieker
  • Fabian Grass
  • Dieter Hahnloser
  • Nicolas DemartinesEmail author
  • Martin Hübner
Original Scientific Report

Abstract

Background

Enhanced recovery (ERAS) guidelines do not differentiate between left- and right-sided colectomies, but differences in recovery have been reported for the two procedure types. We aimed to compare compliance with the ERAS protocol and outcomes after right versus left colectomy.

Methods

Between June 2011 and September 2014, all patients undergoing elective colonic resection were treated according to a standardized ERAS protocol and entered a prospective database. This retrospective analysis compared right and left colectomy regarding application of the ERAS pathway, bowel recovery, complications, and hospital stay.

Results

Eighty-five patients with right colectomy matched well with 138 left-sided resections for baseline demographics. Overall compliance with the ERAS protocol was 76 % for right versus 77 % for left colectomy patients (p = 0.492). First flatus occurred at postoperative day 2 in both groups (p = 0.057); first stool was observed after a median of 3 (right) and 2 days (left), respectively (p = 0.189). Twenty patients (24 %) needed postoperative nasogastric tube after right colectomy compared to 11 patients (8 %) after left colectomy (p = 0.002). Overall complication rates were 49 and 37 % for right and left colectomy, respectively (p = 0.071). Median postoperative length of stay was 6 days (IQR 4–9) after right and 5 days (IQR 4–7.5) after left colectomy (p = 0.020).

Conclusion

Overall compliance with the protocol was equally high in both groups showing that ERAS protocol was applicable for right and left colectomy. Functional recovery however, tended to be slower after right colectomy, and postoperative ileus rate was significantly higher. More cautious early feeding after right colectomy should be considered.

Keywords

Postoperative Ileus Alvimopan Ileus Rate Left Colectomy Colectomy Group 
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.

Abbreviations

ERAS

Enhanced recovery after surgery

POD

Postoperative day

Notes

Compliance with ethical standards

Disclosure

No external funding was required for this study.

Supplementary material

268_2016_3563_MOESM1_ESM.pdf (68 kb)
Supplementary material 1 (PDF 68 kb)

References

  1. 1.
    Greco M, Capretti G, Beretta L et al (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531–1541. doi: 10.1007/s00268-013-2416-8 CrossRefPubMedGoogle Scholar
  2. 2.
    Rawlinson A, Kang P, Evans J, Khanna A (2011) A systematic review of enhanced recovery protocols in colorectal surgery. Ann R Coll Surg Engl 93:583–588CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gustafsson UO, Hausel J, Thorell A et al (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577CrossRefPubMedGoogle Scholar
  4. 4.
    Roulin D, Donadini A, Gander S et al (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg 100:1108–1114CrossRefPubMedGoogle Scholar
  5. 5.
    Wind J, Polle SW, Fung Kon Jin PHP et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809CrossRefPubMedGoogle Scholar
  6. 6.
    Gustafsson UO, Scott MJ, Schwenk W et al (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS(®)) society recommendations. World J Surg 37:259–284. doi: 10.1016/j.clnu.2012.08.013 CrossRefPubMedGoogle Scholar
  7. 7.
    Cakir H, van Stijn MFM, Lopes Cardozo AMF et al (2013) Adherence to enhanced recovery after surgery and length of stay after colonic resection. Colorectal Dis 15:1019–1025CrossRefPubMedGoogle Scholar
  8. 8.
    Veyrie N, Ata T, Muscari F et al (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 205:785–793CrossRefPubMedGoogle Scholar
  9. 9.
    Kwaan MR, Al-Refaie WB, Parsons HM et al (2013) Are right-sided colectomy outcomes different from left-sided colectomy outcomes?: study of patients with colon cancer in the ACS NSQIP database. JAMA Surg 148:504–510CrossRefPubMedGoogle Scholar
  10. 10.
    Bakker IS, Grossmann I, Henneman D et al (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101:424–432 (discussion 432) CrossRefPubMedGoogle Scholar
  11. 11.
    Hinojosa MW, Konyalian VR, Murrell ZA et al (2007) Outcomes of right and left colectomy at academic centers. Am Surg 73:945–948PubMedGoogle Scholar
  12. 12.
    Benedix F, Kube R, Meyer F et al (2010) Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum 53:57–64CrossRefPubMedGoogle Scholar
  13. 13.
    Masoomi H, Buchberg B, Dang P et al (2011) Outcomes of right vs. left colectomy for colon cancer. J Gastrointest Surg 15:2023–2028CrossRefPubMedGoogle Scholar
  14. 14.
    Rana AR, Cannon JA, Mostafa G et al (2007) Outcomes of right-compared with left-side colectomy. Surg Innov 14:91–95CrossRefPubMedGoogle Scholar
  15. 15.
    Senagore AJ, Duepree HJ, Delaney CP et al (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46:503–509CrossRefPubMedGoogle Scholar
  16. 16.
    Neutzling CB, Lustosa SA, Proenca IM et al (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst, RevCrossRefGoogle Scholar
  17. 17.
    Hübner M, Larson DW, Wolff BG (2012) “How I do it”—radical right colectomy with side-to-side stapled ileo-colonic anastomosis. J Gastrointest Surg 16:1605–1609CrossRefPubMedGoogle Scholar
  18. 18.
    Roulin D, Blanc C, Muradbegovic M et al (2014) Enhanced recovery pathway for urgent colectomy. World J Surg 38:2153–2159. doi: 10.1007/s00268-014-2518-y CrossRefPubMedGoogle Scholar
  19. 19.
    Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17:962–972CrossRefPubMedGoogle Scholar
  20. 20.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Moghadamyeghaneh Z, Hwang GS, Hanna MH et al (2015) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30:603–609CrossRefPubMedGoogle Scholar
  22. 22.
    Vather R, Bissett I (2013) Risk factors for the development of prolonged post-operative ileus following elective colorectal surgery. Int J Colorectal Dis 28:1385–1391CrossRefPubMedGoogle Scholar
  23. 23.
    Xu C, Chi P (2014) Relevant factor analysis on postoperative ileus following radical resection for colorectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi Chin J Gastrointest Surg 17:361–364Google Scholar
  24. 24.
    Xu C, Chi P (2012) Comparison of the incidence of postoperative ileus following laparoscopic and open radical resection for colorectal cancer: a meta-analysis. Zhonghua Wei Chang Wai Ke Za Zhi Chin J Gastrointest Surg 15:1044–1047Google Scholar
  25. 25.
    Chapuis PH, Bokey L, Keshava A et al (2013) Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Ann Surg 257:909–915CrossRefPubMedGoogle Scholar
  26. 26.
    Svatek RS, Fisher MB, Williams MB et al (2010) Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology 76:1419–1424CrossRefPubMedGoogle Scholar
  27. 27.
    Vather R, Josephson R, Jaung R et al (2015) Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 157:764–773CrossRefPubMedGoogle Scholar
  28. 28.
    Wolthuis AM, Bislenghi G, Fieuws S et al (2016) Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 18:O1–O9CrossRefPubMedGoogle Scholar
  29. 29.
    Pikarsky AJ, Saida Y, Yamaguchi T et al (2002) Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16:855–858CrossRefPubMedGoogle Scholar
  30. 30.
    Ay AA, Kutun S, Ulucanlar H et al (2011) Risk factors for postoperative ileus. J Korean Surg Soc 81:242–249CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Millan M, Biondo S, Fraccalvieri D et al (2012) Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World J Surg 36:179–185. doi: 10.1007/s00268-011-1339-5 CrossRefPubMedGoogle Scholar
  32. 32.
    Thoker M, Wani I, Parray FQ et al (2014) Role of diversion ileostomy in low rectal cancer: a randomized controlled trial. Int J Surg 12:945–951CrossRefPubMedGoogle Scholar
  33. 33.
    ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159CrossRefGoogle Scholar
  34. 34.
    Ramírez JM, Blasco JA, Roig JV et al (2011) Enhanced recovery in colorectal surgery: a multicentre study. BMC Surg 11:9CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Nelson R, Edwards S, Tse B (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 3:CD004929PubMedGoogle Scholar
  36. 36.
    Postoperative Pain Forum Group, Marret E, Remy C, Bonnet F (2007) Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 94:665–673CrossRefGoogle Scholar
  37. 37.
    Levy BF, Scott MJ, Fawcett W et al (2011) Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg 98:1068–1078CrossRefPubMedGoogle Scholar
  38. 38.
    Hübner M, Blanc C, Roulin D et al (2014) Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg 261:648–653CrossRefGoogle Scholar
  39. 39.
    Bragg D, El-Sharkawy AM, Psaltis E et al (2015) Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr 34:367–376CrossRefPubMedGoogle Scholar
  40. 40.
    Simorov A, Thompson J, Oleynikov D (2014) Alvimopan reduces length of stay and costs in patients undergoing segmental colonic resections: results from multicenter national administrative database. Am J Surg 208:919–925 (discussion 925) CrossRefPubMedGoogle Scholar
  41. 41.
    Abodeely A, Schechter S, Klipfel A et al (2011) Does alvimopan enhance return of bowel function in laparoscopic right colectomy? Am Surg 77:1460–1462PubMedGoogle Scholar
  42. 42.
    Kelley SR, Wolff BG, Lovely JK, Larson DW (2013) Fast-track pathway for minimally invasive colorectal surgery with and without alvimopan (Entereg)™: which is more cost-effective? Am Surg 79:630–633PubMedGoogle Scholar
  43. 43.
    Tan EK, Cornish J, Darzi AW, Tekkis PP (2007) Meta-analysis: alvimopan vs. placebo in the treatment of post-operative ileus. Aliment Pharmacol Ther 25:47–57PubMedGoogle Scholar
  44. 44.
    Sun Y, Li T, Wang N et al (2012) Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 55:1183–1194CrossRefPubMedGoogle Scholar
  45. 45.
    Short V, Herbert G, Perry R et al (2015) Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev 2:CD006506PubMedGoogle Scholar
  46. 46.
    Müller SA, Rahbari NN, Schneider F et al (2012) Randomized clinical trial on the effect of coffee on postoperative ileus following elective colectomy. Br J Surg 99:1530–1538CrossRefPubMedGoogle Scholar
  47. 47.
    Zingg U, Miskovic D, Pasternak I et al (2008) Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial. Int J Colorectal Dis 23:1175–1183CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Anne Kummer
    • 1
  • Juliette Slieker
    • 1
  • Fabian Grass
    • 1
  • Dieter Hahnloser
    • 1
  • Nicolas Demartines
    • 1
    Email author
  • Martin Hübner
    • 1
  1. 1.Department of Visceral SurgeryUniversity Hospital of Lausanne (CHUV)LausanneSwitzerland

Personalised recommendations