Can the combination of laparoscopy and enhanced recovery improve long-term survival after elective colorectal cancer surgery?

Curtis, Nathan; Taylor, Matthew; Fraser, Lorna; Salib, Emad; Noble, Emma; Hipkiss, Rob; Allison, Andrew; Dalton, Richard; Ockrim, Jonathan; Francis, Nader

doi:10.1007/s00384-017-2935-0

Cited by 21 publications

(19 citation statements)

References 12 publications

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“…After adjustment for BMI, tumour location and neoadjuvant treatment, compliance may have been associated with a reduction in 5‐year cancer‐specific mortality. Others have reported better OS for patients undergoing laparoscopic surgery within an ERP.…”

Section: Discussionmentioning

confidence: 96%

“…Given the advantages of ERPs and MIS, a combination of both may potentiate improvements in cancer‐related outcomes. One recent study within an enhanced recovery framework demonstrated improved oncological results in MIS surgery, and other authors have described a correlation between ERP compliance and improved 5‐year oncological outcomes. Both series used robust follow‐up data, but these were aggregated from heterogeneous patient populations, which featured colonic and rectal cancers treated with both open and minimally invasive techniques.…”

Section: Introductionmentioning

confidence: 99%

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Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer

Quiram

Crippa

Grass

et al. 2019

British Journal of Surgery

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Background: Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer. Methods: This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care.Results: A total of 600 patients underwent minimally invasive surgery, of whom 320 (53⋅3 per cent) were treated according to the ERP and 280 (46⋅7 per cent) received conventional care. ERP was associated with less overall morbidity (34⋅7 versus 54⋅3 per cent; P < 0⋅001). Patients in the ERP group had improved overall survival on univariable (91⋅4 versus 81⋅7 per cent at 5 years; hazard ratio (HR) 0⋅53, 95 per cent c.i. 0⋅28 to 0⋅99) but not multivariable (HR 0⋅78, 0⋅41 to 1⋅50) analysis. Multivariable analysis revealed age (HR 1⋅46, 1⋅17 to 1⋅82), male sex (HR 1⋅98, 1⋅05 to 3⋅70) and complications (HR 2⋅23, 1⋅30 to 3⋅83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80⋅5 versus 84⋅6 per cent at 5 years respectively; P = 0⋅272).Conclusion: Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer

Quiram

Crippa

Grass

et al. 2019

British Journal of Surgery

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“…Of these 26 articles, 3 were randomized trials [ 12 , 13 , 15 ], which were evaluated by Jadad score, and the other 23 were prospective or retrospective cohort studies, which were evaluated by the NOS. Eighteen articles compared conventional care with ERAS [ 10 – 21 , 29 – 34 ], 7 studies compared high adherence to ERAS with low adherence [ 16 , 22 – 26 , 34 ], and 4 studies [ 27 – 29 , 35 ] investigated the outcome of one single item altered within ERAS protocol. The elements of the ERAS protocol in each article are presented in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries — a systematic review

et al. 2021

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Background Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted. Methods The Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: “ERAS” or “enhanced recovery” or “fast track”, “oncologic outcome”, “recurrence”, “metastasis”, “long-term outcomes”, “survival”, and “cancer surgery”. The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed. Results A total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy. Conclusions The use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival.

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“…The pathogenesis of colorectal cancer still remains unknown as there are numerous pathogenic factors, which makes the treatment of colorectal cancer more difficult ( 5 – 7 ). Surgical resection has been the radical treatment for colorectal cancer; however, the probability of infection after surgery is high, resulting in poor survival rate of patients ( 8 , 9 ). Therefore, the relevant mechanisms of colorectal cancer need to be clarified and new potential therapeutic targets should be investigated to improve the prognosis of patients with colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

miR‑452‑5p and miR‑215‑5p expression levels in colorectal cancer tissues and their relationship with clinicopathological features

Dou

et al. 2020

Oncol Lett

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The aim of the study was to investigate the expression levels of miR-452-5p and miR-215-5p in colorectal cancer tissues and their relationship with clinicopathological features. A total of 50 specimens of cancerous and adjacent normal tissues were collected from patients with colorectal cancer who underwent surgical resection at the Xingtai People's Hospital from March 2012 to February 2014. All specimens were confirmed by the Department of Pathology. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to measure the expression levels of miR-452-5p and miR-215-5p in cancerous and adjacent normal tissues. Moreover, the relationship of the expression levels of miR-452-5p and miR-215-5p with the clinicopathological features of patients with colorectal cancer was explored. The expression levels of both miR-452-5p and miR-215-5p in colorectal cancer tissues were significantly lower than those in adjacent normal tissues (P<0.05). miR-452-5p expression was related to tumor-node-metastasis (TNM) staging and differentiation degree in colorectal cancer tissues, and the expression of miR-215-5p was associated with TNM staging, lymph node metastasis and infiltration depth (P<0.05). The 5-year overall survival (OS) rate in the miR-452-5p high-expression group was significantly higher than that in the low-expression group (P<0.05). The 5-year OS rates in the miR-215-5p high-and low-expression groups were 53.57% (15/28) and 40.91% (9/22), respectively, indicating that the 5-year OS rate in the miR-215-5p high-expression group was significantly higher than that in the low-expression group. Cox proportional hazards regression model showed that TNM staging, lymph node metastasis, as well as miR-452-5p and miR-215-5p expression levels were independent risk factors affecting colorectal cancer prognosis (P<0.05), whereas the differentiation degree and infiltration depth were not (P>0.05). In conclusion, the expression levels of miR-452-5p and miR-215-5p were significantly downregulated in colorectal cancer tissues promoting the occurrence, progression, invasion and metastasis of colorectal cancer, which suggests that miR-452-5p and miR-215-5p could be used as prognostic indicators for patients with colorectal cancer.

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Can the combination of laparoscopy and enhanced recovery improve long-term survival after elective colorectal cancer surgery?

Abstract: The use of a laparoscopic approach with enhanced recovery after surgery management appears to have long-term survival benefits following colorectal cancer resection.

Cited by 21 publications

References 12 publications

Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer

Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer

Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries — a systematic review

miR‑452‑5p and miR‑215‑5p expression levels in colorectal cancer tissues and their relationship with clinicopathological features

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