Hélène Meillat1, Clément Brun2, Christophe Zemmour3,4, Cécile de Chaisemartin5, Olivier Turrini5, Marion Faucher2, Bernard Lelong5. 1. Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France. meillath@ipc.unicancer.fr. 2. Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France. 3. Inst Paoli Calmettes, Dept Clin Res & Invest, Biostat & Methodolo Unit, Marseille, France. 4. Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France. 5. Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France.
Abstract
BACKGROUND: The enhanced recovery after surgery (ERAS) programs and laparoscopic techniques both reduce hospital stay and postoperative morbidity in patients undergoing colorectal cancer surgery. Laparoscopic techniques are an integral part of the ERAS program. However, evidence showing that the implementation of a multimodal rehabilitation program in addition to laparoscopy for colonic cancer would improve postoperative outcomes is still lacking. This study aimed to evaluate the impact of ERAS program on postoperative outcomes after elective laparoscopic colonic cancer resection. METHODS: This is a single-center observational study from a prospectively maintained database. Two groups were formed from all patients undergoing laparoscopic colonic surgery for neoplasm during a defined period before (standard group) and after introduction of an ERAS program (ERAS group). The primary endpoint was postoperative 90-day morbidity. Secondary endpoints were the total length of hospital stay, readmission rate, and compliance with ERAS protocol. RESULTS: A total of 320 patients were included in the analyses, with 160 patients in the standard group and 160 in the ERAS group. There were no differences in the baseline characteristics between the two groups. Overall morbidity was significantly lower in the ERAS group (21.25%) than that in the standard group (34.4%; OR = 0.52 [0.31-0.85], p < 0.01). This difference was not due to the reduction in major complications. Mean total hospital stay was significantly lower in the ERAS group (5.8 days) than that in the standard group (8.2 days, p < 0.01). There were no differences in readmission rates and anastomotic complications. CONCLUSIONS: The ERAS pathway reduced the overall morbidity rates and shortened the length of hospital stay, without increasing the readmission rates. A significant reduction in nonsurgical complications was evident, whereas no significant reduction was found for surgical complications.
BACKGROUND: The enhanced recovery after surgery (ERAS) programs and laparoscopic techniques both reduce hospital stay and postoperative morbidity in patients undergoing colorectal cancer surgery. Laparoscopic techniques are an integral part of the ERAS program. However, evidence showing that the implementation of a multimodal rehabilitation program in addition to laparoscopy for colonic cancer would improve postoperative outcomes is still lacking. This study aimed to evaluate the impact of ERAS program on postoperative outcomes after elective laparoscopic colonic cancer resection. METHODS: This is a single-center observational study from a prospectively maintained database. Two groups were formed from all patients undergoing laparoscopic colonic surgery for neoplasm during a defined period before (standard group) and after introduction of an ERAS program (ERAS group). The primary endpoint was postoperative 90-day morbidity. Secondary endpoints were the total length of hospital stay, readmission rate, and compliance with ERAS protocol. RESULTS: A total of 320 patients were included in the analyses, with 160 patients in the standard group and 160 in the ERAS group. There were no differences in the baseline characteristics between the two groups. Overall morbidity was significantly lower in the ERAS group (21.25%) than that in the standard group (34.4%; OR = 0.52 [0.31-0.85], p < 0.01). This difference was not due to the reduction in major complications. Mean total hospital stay was significantly lower in the ERAS group (5.8 days) than that in the standard group (8.2 days, p < 0.01). There were no differences in readmission rates and anastomotic complications. CONCLUSIONS: The ERAS pathway reduced the overall morbidity rates and shortened the length of hospital stay, without increasing the readmission rates. A significant reduction in nonsurgical complications was evident, whereas no significant reduction was found for surgical complications.
Entities:
Keywords:
Colon cancer; Compliance; Enhanced recovery after surgery; Laparoscopic surgery
Authors: Marco Braga; Andrea Vignali; Luca Gianotti; Walter Zuliani; Giovanni Radaelli; Paola Gruarin; Paolo Dellabona; Valerio Di Carlo Journal: Ann Surg Date: 2002-12 Impact factor: 12.969
Authors: Kristoffer Lassen; Mattias Soop; Jonas Nygren; P Boris W Cox; Paul O Hendry; Claudia Spies; Maarten F von Meyenfeldt; Kenneth C H Fearon; Arthur Revhaug; Stig Norderval; Olle Ljungqvist; Dileep N Lobo; Cornelis H C Dejong Journal: Arch Surg Date: 2009-10
Authors: Ruben Veldkamp; Esther Kuhry; Wim C J Hop; J Jeekel; G Kazemier; H Jaap Bonjer; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio M Lacy Journal: Lancet Oncol Date: 2005-07 Impact factor: 41.316
Authors: Pierre J Guillou; Philip Quirke; Helen Thorpe; Joanne Walker; David G Jayne; Adrian M H Smith; Richard M Heath; Julia M Brown Journal: Lancet Date: 2005 May 14-20 Impact factor: 79.321
Authors: Andrew P Stillwell; Petra G Buettner; Simon K Siu; Russell W Stitz; Andrew R L Stevenson; Yik-Hong Ho Journal: Dis Colon Rectum Date: 2011-05 Impact factor: 4.585
Authors: Mateusz Rubinkiewicz; Magdalena Pisarska; Piotr Zarzycki; Katarzyna Truszkiewicz; Jan Witowski; Michael Su; Robert Kupis; Anna Gajdosz; Michał Pędziwiatr Journal: Wideochir Inne Tech Maloinwazyjne Date: 2020-02-04 Impact factor: 1.195