Background: Robotic surgery and ERAS protocol care are both prominent developments and have each become global trends. However, the effects and learning curves of combining robotic surgery and ERAS care in colorectal resection have not yet been well validated. This study aimed to present our real-world experience and establish the learning curves necessary for the implementation of an ERAS program in minimally-invasive surgery for colorectal resection, while also evaluating the impact that the development of the robotic technique has on ERAS outcomes. Methods: A total of 155 patients who received elective, minimally-invasive surgery, including laparoscopic and robotic surgery for colorectal resection, with ERAS care during the period June 2019 to September 2021 were included in this retrospective analysis. Patients were divided chronologically into five groups (31 cases per quintile). Patient demographics, tumor characteristics, perioperative data, ERAS compliance, and surgical outcomes were all compared among the quintiles. Learning curves were evaluated based on ERAS compliance and optimal recovery, which are composed of an absence of major complications, postoperative length of stay (LOS) of no more than five days, and no readmission within 30 days. A multivariable logistic regression model was used to assess factors associated with postoperative LOS. Results: There were no statistically significant differences seen overall or between the quintile groups in regards to demographic and tumor characteristic parameters. A total of 79 patients (51%) received robotic surgery, with the ratio of robotic groups rising chronologically from zero in the first quintile to 90.3% in the fifth quintile (p < 0.001). The median compliance rate of total ERAS protocol was 83.3% overall, 72.2% in the first quintile and 83.3% in the 2nd–5th quintiles (p < 0.001). A total of 85 patients underwent optimal recovery after surgery, four patients in the first quintile, 11 patients in the second quintile, and 21, 24, 25 patients in the 3rd–5th quintiles respectively (p < 0.001). There were significant improvements from early to later groups upon postoperative LOS (p < 0.001). In addition, the surgical outcomes including first oral intake within 24 hours after surgery, time to first stool and early termination of intravenous fluid administration showed significant improvement among the quintiles. A multivariable logistic regression model demonstrated that robotic surgery was superior to laparoscopic surgery upon postoperative LOS (odds ratio = 5.029, 95% confidence interval [CI] = 1.321 to 19.142; p = 0.018). Conclusions: Our experience demonstrated that an effective implementation of the ERAS program in minimally-invasive colorectal surgery requires 31 patients to accomplish the higher compliance and requires more cases to reach the maturation phase for optimal recovery. We believe that developing a robotic platform would have no impact on the learning curve of ERAS implementation. Moreover, there is a beneficial effect on the postoperative length of surgery provided through the combination of ERAS care and robotic surgery for patients undergoing colorectal resection.

Background: Bevacizumab-awwb (MVASI®) is the first and the only bevacizumab biosimilar made available in Taiwan. However, its extrapolation of indication and the lack of available real-world clinical data has raised some concern. This article is aimed at presenting our real-world experience in the use of MVASI for treating patients with metastatic Colorectal Cancer (mCRC) for purposes of evaluating tumor response and safety. Materials & Methods: Adult patients from a single institution initiating MVASI use following an mCRC diagnosis during the period of May 2020 to August 2021 were included in the study. Each patient's demographics and tumor characteristics were collated retrospectively. We described treatment patterns and evaluated treatment efficacy stratified by initiating MVASI as either first line or later line therapy. Results: A total of 20 patients were identified, with 2 being excluded due to incomplete therapy and lost follow-up. The mean age of the subjects was 58.7 years. Most patients had a left-sided colorectal tumor (83.3%) and underwent a primary tumor resection (94%) prior to systemic antineoplastic therapy. Fourteen out of 18 patients initiated MVASI use as first line therapy, where the Disease-control Rate (DCR) was 85.7%. Alternatively, four out of 18 patients in later line therapy all experienced disease progression, with progression-free survival (PFS) ranging 4 to 10 months. Five patients had prior bevacizumab reference product utilization but switched to MVASI mostly due to economic issues, with three of these patients (60%) showing progression disease (PFS ranging 3-10 months). Only two patients (11%) encountered adverse events during MVASI therapy. Conclusion: Both the efficacy and safety of MVASI in the mCRC population are deemed comparable with the bevacizumab reference product, exclusively at first line therapy. The strategy of switching between the biosimilar and reference product is currently controversial, and therefore further studies are still required.