Skip to main content
SpringerLink
Log in

Feasibility of the ERAS (Enhanced Recovery After Surgery) Protocol in Patients Undergoing Gastrointestinal Cancer Surgeries in a Tertiary Care Hospital—A Prospective Interventional Study

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Enhanced Recovery After Surgery (ERAS) protocols have emerged as a promising approach to optimize perioperative care and improve outcomes in various surgical specialties. Despite feasibility studies on ERAS in various surgeries, there remains a paucity of research focusing on gastrointestinal cancer surgeries in the Indian context. The primary objective is to evaluate the compliance rate of the ERAS protocol and secondary objectives include the compliance rate of individual components of the protocol, the complications, the length of hospital stay, and the challenges faced during implementation in patients undergoing gastrointestinal cancer surgeries in our tertiary care cancer center. In this prospective interventional study (CTRI/2022/04/041657; registered on 05/04/2022), we evaluated 50 patients aged 18 to 70 years undergoing surgery for gastrointestinal malignancies and implemented a refined ERAS protocol tailored to our institutional resources and conditions based on standard ERAS society recommendations for gastrointestinal surgeries and specific recommendations for colorectal, pancreatic, and esophageal surgeries.Our study’s mean overall compliance rate with the ERAS protocol was 88.54%. We achieved a compliance rate of 91.98%, 81.66%, and 92.00% for pre-operative, intraoperative, and post-operative components respectively. Fourteen (28%) patients experienced complications during the study. The median length of stay was 6.5 days (5.25–8). Challenges were encountered during the preoperative, intraoperative, and postoperative phases. The study highlighted the feasibility of implementing the ERAS protocol in a cancer institute, but specific challenges need to be addressed for its optimal success in gastrointestinal cancer surgeries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data of all the patients from which the results have been derived is available on request.

References

  1. Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198. https://doi.org/10.1097/SLA.0b013e31817f2c1a

    Article  PubMed  Google Scholar 

  2. Melnyk M, Casey RG, Black P, Koupparis AJ (2013) Enhanced Recovery After Surgery (ERAS) protocols: time to change practice? Can Urol Assoc J 5:342. https://doi.org/10.5489/cuaj.693

    Article  Google Scholar 

  3. Pędziwiatr M, Wierdak M, Nowakowski M et al (2016) Cost minimization analysis of laparoscopic surgery for colorectal cancer within the Enhanced Recovery After Surgery (ERAS) protocol: a single-centre, case-matched study. Wideochir Inne Tech Malo Inwazyjne 11:14–21. https://doi.org/10.5114/wiitm.2016.58617

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ljungqvist O (2014) ERAS–Enhanced Recovery After Surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr 38:559–566. https://doi.org/10.1177/0148607114523451

    Article  PubMed  Google Scholar 

  5. 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. https://doi.org/10.1007/s00268-012-1772-0

    Article  CAS  PubMed  Google Scholar 

  6. Gustafsson UO, Scott MJ, Hubner M et al (2019) Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) society recommendations: 2018. World J Surg 43:659–695. https://doi.org/10.1007/s00268-018-4844-y

    Article  CAS  PubMed  Google Scholar 

  7. Nygren J, Thacker J, Carli F et al (2012) Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) society recommendations. Clin Nutr 31:801–816. https://doi.org/10.1016/j.clnu.2012.08.012

    Article  CAS  PubMed  Google Scholar 

  8. Fearon KCH, Ljungqvist O, Von Meyenfeldt M et al (2005) Enhanced Recovery After Surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477. https://doi.org/10.1016/j.clnu.2005.02.002

    Article  CAS  PubMed  Google Scholar 

  9. Lassen K, Soop M, Nygren J et al (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) group recommendations. Arch Surg 144:961–969. https://doi.org/10.1001/archsurg.2009.170

    Article  PubMed  Google Scholar 

  10. Zhuang C-L, Ye X-Z, Zhang X-D et al (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. https://doi.org/10.1097/DCR.0b013e3182812842

    Article  PubMed  Google Scholar 

  11. Varadhan KK, Lobo DN, Ljungqvist O (2010) Enhanced Recovery After Surgery: the future of improving surgical care. Crit Care Clin 26:527–47, x.https://doi.org/10.1016/j.ccc.2010.04.003

  12. Rahbari NN, Zimmermann JB, Schmidt T et al (2009) Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 96:331–341. https://doi.org/10.1002/bjs.6552

    Article  CAS  PubMed  Google Scholar 

  13. Bijker JB, van Klei WA, Vergouwe Y et al (2009) Intraoperative hypotension and 1-year mortality after noncardiac surgery. Anesthesiology 111:1217–1226. https://doi.org/10.1097/ALN.0b013e3181c14930

    Article  PubMed  Google Scholar 

  14. Feldheiser A, Aziz O, Baldini G et al (2016) Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 60:289–334. https://doi.org/10.1111/aas.12651

    Article  CAS  PubMed  Google Scholar 

  15. Polle SW, Wind J, Fuhring JW et al (2007) Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 24:441–449. https://doi.org/10.1159/000108327

    Article  PubMed  Google Scholar 

  16. Pal AR, Mitra S, Aich S, Goswami J (2019) Existing practice of perioperative management of colorectal surgeries in a regional cancer institute and compliance with ERAS guidelines. Indian J Anaesth 63:26–30. https://doi.org/10.4103/ija.IJA_382_18

    Article  PubMed  PubMed Central  Google Scholar 

  17. Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362:1225–1230. https://doi.org/10.1016/S0140-6736(03)14546-1

    Article  PubMed  Google Scholar 

  18. Maessen J, Dejong CHC, Hausel J et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231. https://doi.org/10.1002/bjs.5468

    Article  CAS  PubMed  Google Scholar 

  19. Low GMI, Kiong KL, Amaku R et al (2020) Feasibility of an Enhanced Recovery After Surgery (ERAS) pathway for major head and neck oncologic surgery. Am J Otolaryngol 41:102679. https://doi.org/10.1016/j.amjoto.2020.102679

    Article  PubMed  Google Scholar 

  20. Pędziwiatr M, Kisialeuski M, Wierdak M et al (2015) Early implementation of Enhanced Recovery After Surgery (ERAS®) protocol – compliance improves outcomes: a prospective cohort study. Int J Surg 21:75–81. https://doi.org/10.1016/j.ijsu.2015.06.087

    Article  PubMed  Google Scholar 

  21. Roulin D, Melloul E, Wellg BE et al (2020) Feasibility of an enhanced recovery protocol for elective pancreatoduodenectomy: a multicenter international cohort study. World J Surg 44:2761–2769. https://doi.org/10.1007/s00268-020-05499-x

    Article  PubMed  Google Scholar 

  22. Ahmed J, Khan S, Gatt M et al (2010) Compliance with enhanced recovery programmes in elective colorectal surgery. Br J Surg 97:754–758. https://doi.org/10.1002/bjs.6961

    Article  CAS  PubMed  Google Scholar 

  23. Bakker N, Cakir H, Doodeman HJ, Houdijk APJ (2015) Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: impact of measures to improve adherence. Surgery 157:1130–1136. https://doi.org/10.1016/j.surg.2015.01.016

    Article  PubMed  Google Scholar 

  24. Aarts M-A, Rotstein OD, Pearsall EA et al (2018) Postoperative ERAS interventions have the greatest impact on optimal recovery: experience with implementation of ERAS across multiple hospitals. Ann Surg 267:992–997. https://doi.org/10.1097/SLA.0000000000002632

    Article  PubMed  Google Scholar 

  25. Gillissen F, Hoff C, Maessen JMC et al (2013) Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in the Netherlands. World J Surg 37:1082–1093. https://doi.org/10.1007/s00268-013-1938-4

    Article  PubMed  Google Scholar 

  26. Ju YU, Min BW (2021) A review of bowel preparation before colorectal surgery. Ann Coloproctol 37:75–84. https://doi.org/10.3393/ac.2020.04.01

    Article  PubMed  Google Scholar 

  27. Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum 41:875–882. https://doi.org/10.1007/bf02235369

    Article  CAS  PubMed  Google Scholar 

  28. Lewis J, Kinross J (2019) Mechanical bowel preparation for elective colorectal surgery. Tech Coloproctol 23:783–785. https://doi.org/10.1007/s10151-019-02061-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Slim K, Vicaut E, Panis Y, Chipponi J (2004) Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91:1125–1130. https://doi.org/10.1002/bjs.4651

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India

    Surya Theja, Rakesh Garg, Sachidanand Jee Bharati, Vinod Kumar, Nishkarsh Gupta, Saurabh Vig & Sushma Bhatnagar

  2. Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, Room No. 249, Second Floor, New Delhi, Delhi, India

    Seema Mishra

  3. Department of Surgical Oncology, Dr. BRAIRCH, AIIMS, New Delhi, Delhi, India

    Sandeep Bhoriwal, Sunil Kumar & S. V. S. Deo

Authors
  1. Surya Theja
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seema Mishra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandeep Bhoriwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rakesh Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sachidanand Jee Bharati
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vinod Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nishkarsh Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Saurabh Vig
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sunil Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. V. S. Deo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sushma Bhatnagar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seema Mishra.

Ethics declarations

Ethics Approval

This research was conducted after approval from the institutional ethics committee.

Consent to Participate

All participants provided informed consent for the study.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 33 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Theja, S., Mishra, S., Bhoriwal, S. et al. Feasibility of the ERAS (Enhanced Recovery After Surgery) Protocol in Patients Undergoing Gastrointestinal Cancer Surgeries in a Tertiary Care Hospital—A Prospective Interventional Study. Indian J Surg Oncol 15, 304–311 (2024). https://doi.org/10.1007/s13193-024-01897-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-024-01897-y

Keywords

Search

Navigation