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

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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.

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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).

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Authors and Affiliations

  1. Department of General Surgery, Zhongshan Hospital, Fudan University Medical Center, Shanghai, 200032, People’s Republic of China

    Li Ren, Dexiang Zhu, Ye Wei, Xiangou Pan, Li Liang, Jianmin Xu, Yunshi Zhong, Weixin Niu, Xinyu Qin, Zhaohan Wu & Zhaoguang Wu

  2. Colorectal Cancer Research Center, Fudan University, Shanghai, People’s Republic of China

    Li Ren, Dexiang Zhu, Ye Wei, Xiangou Pan, Li Liang, Jianmin Xu, Yunshi Zhong, Weixin Niu, Xinyu Qin, Zhaohan Wu & Zhaoguang Wu

  3. Institute of General Surgery, Fudan University, Shanghai, People’s Republic of China

    Li Ren, Dexiang Zhu, Ye Wei, Xiangou Pan, Li Liang, Jianmin Xu, Yunshi Zhong, Weixin Niu, Xinyu Qin, Zhaohan Wu & Zhaoguang Wu

  4. Department of Surgery, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China

    Li Ren, Dexiang Zhu, Ye Wei, Xiangou Pan, Li Liang, Jianmin Xu, Yunshi Zhong, Weixin Niu, Xinyu Qin, Zhaohan Wu & Zhaoguang Wu

  5. Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China

    Zhanggang Xue & Ling Jin

  6. Department of Statistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China

    Shaokang Zhan

Authors
  1. Li Ren
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  2. Dexiang Zhu
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  3. Ye Wei
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  4. Xiangou Pan
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  5. Li Liang
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  7. Yunshi Zhong
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  8. Zhanggang Xue
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  9. Ling Jin
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  10. Shaokang Zhan
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  11. Weixin Niu
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  12. Xinyu Qin
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  13. Zhaohan Wu
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  14. Zhaoguang Wu
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Corresponding author

Correspondence to Jianmin Xu.

Additional information

L. Ren, D. Zhu, and Y. Wei are to be considered as first co-authors.

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Ren, L., Zhu, D., Wei, Y. et al. Enhanced Recovery After Surgery (ERAS) Program Attenuates Stress and Accelerates Recovery in Patients After Radical Resection for Colorectal Cancer: A Prospective Randomized Controlled Trial. World J Surg 36, 407–414 (2012). https://doi.org/10.1007/s00268-011-1348-4

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  • DOI: https://doi.org/10.1007/s00268-011-1348-4

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