Skip to main content

Enhanced recovery after surgery in emergency resection for obstructive colorectal cancer: a systematic review and meta-analysis

International Journal of Colorectal Disease volume 35, pages 1453–1461 (2020)Cite this article

Abstract

Purpose

Enhanced recovery after surgery (ERAS) improves outcomes after elective colorectal operations. Whether it is beneficial for emergency colorectal surgery is unclear. This study aimed to systematically review and summarize evidence from all studies comparing ERAS versus conventional care in patients having emergency colectomy and/or proctectomy for obstructive colorectal cancer.

Methods

EMBASE, MEDLINE, and PUBMED from 1981 to December 2019 were systematically searched. Any studies comparing our primary outcome of interest (length of hospitalization) among patients having emergency resection for obstructive colorectal cancer who received ERAS versus conventional care were selected. Primary outcome was length of hospitalization. Secondary outcomes were gastrointestinal recovery, postoperative complication, 30-day readmission and mortality, and time to start adjuvant therapy.

Results

Three cohort studies with 818 participants (418 received ERAS and 400 received conventional care) were included. Length of hospitalization (mean reduction 3.07 days; 95% CI, − 3.91 to − 2.23) and risk of overall complication (risk ratio 0.78; 95% CI, 0.63 to 0.97) were significantly lower in ERAS than in conventional care. ERAS was also associated with quicker time to gastrointestinal recovery, a lower incidence of ileus, and a shorter interval between operation and commence of adjuvant chemotherapy. There was no significant difference in the rates of anastomotic leakage, surgical site infection, reoperation, readmission, and mortality within 30 days after surgery between groups.

Conclusions

ERAS had advantages over conventional care in patients undergoing emergency resection for obstructive colorectal cancer—including a shorter length of hospitalization, a lower incidence of overall complication, and a quicker gastrointestinal recovery.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Data availability

All data analyzed during this study are included in this published article.

References

  1. Barrow E, Anderson ID, Varley S, Pichel AC, Peden CJ, Saunders DI, Murray D (2013) Current UK practice in emergency laparotomy. Ann R Coll Surg Engl 95:599–603

    CAS  Article  Google Scholar 

  2. Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, Salim A, Havens JM (2016) Use of national burden to define operative emergency general surgery. JAMA Surg 151:e160480

    Article  Google Scholar 

  3. Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, Agresta F, Allievi N, Bellanova G, Coccolini F, Coy C, Fugazzola P, Martinez CA, Montori G, Paolillo C, Penachim TJ, Pereira B, Reis T, Restivo A, Rezende-Neto J, Sartelli M, Valentino M, Abu-Zidan FM, Ashkenazi I, Bala M, Chiara O, De’ Angelis N, Deidda S, De Simone B, Di Saverio S, Finotti E, Kenji I, Moore E, Wexner S, Biffl W, Coimbra R, Guttadauro A, Leppaniemi A, Maier R, Magnone S, Mefire AC, Peitzmann A, Sakakushev B, Sugrue M, Viale P, Weber D, Kashuk J, Fraga GP, Kluger I, Catena F, Ansaloni L (2018) 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 13:36

    Article  Google Scholar 

  4. Aquina CT, Becerra AZ, Xu Z, Boscoe FP, Schymura MJ, Noyes K, Monson JRT, Fleming FJ (2017) Nonelective colon cancer resection: a continued public health concern. Surgery 161:1609–1618

    Article  Google Scholar 

  5. Kulaylat AS, Pappou E, Philp MM, Kuritzkes BA, Ortenzi G, Hollenbeak CS, Choi C, Messaris E (2019) Emergent colon resections: does surgeon specialization influence outcomes? Dis Colon Rectum 62:79–87

    Article  Google Scholar 

  6. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298

    Article  Google Scholar 

  7. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440

    Article  Google Scholar 

  8. Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678

    Article  Google Scholar 

  9. Greer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, Sultan S, Wilt TJ (2018) Enhanced recovery protocols for adults undergoing colorectal surgery: a systematic review and meta-analysis. Dis Colon Rectum 61:1108–1118

    Article  Google Scholar 

  10. Lohsiriwat V (2014) Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol 20:13950–13955

    Article  Google Scholar 

  11. Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, Miyamoto S, Inoue S, Umekita N (2017) Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg 17:18

    Article  Google Scholar 

  12. Shang Y, Guo C, Zhang D (2018) Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer: a propensity score matching analysis. Medicine (Baltimore) 97:e12348

    Article  Google Scholar 

  13. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  Google Scholar 

  14. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2020) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.

  15. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    CAS  Article  Google Scholar 

  16. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  Google Scholar 

  17. Lohsiriwat V (2019) Enhanced recovery after surgery for emergency colorectal surgery: are there any differences between intra-abdominal infection and other indications? J Visc Surg 156:489–496

    CAS  Article  Google Scholar 

  18. Barbieux J, Hamy A, Talbot MF, Casa C, Mucci S, Lermite E, Venara A (2017) Does enhanced recovery reduce postoperative ileus after colorectal surgery? J Visc Surg 154:79–85

    CAS  Article  Google Scholar 

  19. Lau C, Phillips E, Bresee C, Fleshner P (2014) Early use of low residue diet is superior to clear liquid diet after elective colorectal surgery: a randomized controlled trial. Ann Surg 260:641–647

    Article  Google Scholar 

  20. Lohsiriwat V (2019) Mosapride reduces prolonged postoperative ileus after open colorectal surgery in the setting of enhanced recovery after surgery (ERAS): a matched case-control study. Siriraj Med J 71:181–188

    Article  Google Scholar 

  21. Zhang C, Yin S, Tan Y, Huang J, Wang P, Hou W, Zhang Z, Xu H (2020) Patient selection for adjuvant chemotherapy in high-risk stage II colon cancer: a systematic review and meta-analysis. Am J Clin Oncol 43:279–287

  22. Strouch MJ, Zhou G, Fleshman JW, Birnbaum EH, Hunt SR, Mutch MG (2013) Time to initiation of postoperative chemotherapy: an outcome measure for patients undergoing laparoscopic resection for rectal cancer. Dis Colon Rectum 56:945–951

    Article  Google Scholar 

  23. Yoshida Y, Aisu N, Kojima D, Mera T, Kiyomi F, Yamashita Y, Hasegawa S (2017) Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02). Ann Gastroenterol Surg 1:219–225

    Article  Google Scholar 

  24. Gao P, Huang XZ, Song YX, Sun JX, Chen XW, Sun Y, Jiang YM, Wang ZN (2018) Impact of timing of adjuvant chemotherapy on survival in stage III colon cancer: a population-based study. BMC Cancer 18:234

    Article  Google Scholar 

  25. Lohsiriwat V, Jitmungngan R (2019) Enhanced recovery after surgery in emergency colorectal surgery: review of literature and current practices. World J Gastrointest Surg 11:41–52

    Article  Google Scholar 

  26. ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159

    Article  Google Scholar 

  27. Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA, Sprangers MA, Cuesta MA, Bemelman WA, LAFA study group (2011) 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 254:868–875

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lung Road, Bangkok, 10700, Thailand

    Varut Lohsiriwat

  2. The Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand

    Romyen Jitmungngan

  3. Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Weeraput Chadbunchachai

  4. Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Patompong Ungprasert

Authors
  1. Varut Lohsiriwat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Romyen Jitmungngan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weeraput Chadbunchachai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patompong Ungprasert
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VL and PU outlined the content. VL, RJ, and WC reviewed literature and collected data. VL and PU analyzed data and wrote the manuscript. RJ and WC critically reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Varut Lohsiriwat.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

Not applicable. (The identity of the subjects under this systematic review and meta-analysis was omitted and anonymized.)

Consent to participate

Not applicable. (The identity of the subjects under this systematic review and meta-analysis was omitted and anonymized.)

Consent for publication

Not applicable. (The identity of the subjects under this systematic review and meta-analysis was omitted and anonymized.)

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lohsiriwat, V., Jitmungngan, R., Chadbunchachai, W. et al. Enhanced recovery after surgery in emergency resection for obstructive colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 35, 1453–1461 (2020). https://doi.org/10.1007/s00384-020-03652-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-020-03652-5

Keywords

  • Enhanced recovery
  • Colon cancer
  • Rectum cancer
  • Obstruction
  • Emergency
  • Surgery