Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients

Vignali, Andrea; Elmore, Ugo; Guarneri, Giovanni; Ruvo, Valentino De; Rosati, Riccardo

doi:10.1007/s13304-020-00848-w

Cited by 10 publications

(10 citation statements)

References 39 publications

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“…In a retrospective analysis on 733 patients Vignali et al [ 3 ] demonstrated that only non-compliance with the intra-operative balanced fluid therapy, failure to early removal of the urinary catheter, to discontinue intravenous fluid and to early mobilization were independently associated with ERAS failure.…”

Section: Discussionmentioning

confidence: 99%

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ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

Milone

Elmore²,

Manigrasso

et al. 2022

Surg Endosc

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Background Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery. However, it is difficult to obtain full adherence to the protocol into clinical practice and has still not been identified the threshold beyond which improved functional results can be reached. Methods The ERCOLE (ERas and COLorectal Endoscopic surgery) study was as a cohort, prospective, multi-centre national study evaluating the association between adherence to ERAS items and clinical outcomes after minimally invasive colorectal surgery. The primary endpoint was to associate the percentage of ERAS adherence to functional recovery after minimally invasive colorectal cancer surgery. The secondary endpoints of the study was to validate safety of the ERAS programme evaluating complications’ occurrence according to Clavien-Dindo classification and to evaluate the compliance of the Italian surgeons to each ERAS item. Results 1138 patients were included. Adherence to the ERAS protocol was full only in 101 patients (8.9%), > 75% of the ERAS items in 736 (64.7%) and > 50% in 1127 (99%). Adherence to > 75% was associated with a better functional recovery with 90.2 ± 98.8 vs 95.9 ± 33.4 h (p = 0.003). At difference, full adherence to the ERAS components 91.7 ± 22.1 vs 92.2 ± 31.6 h (p = 0.8) was not associated with better recovery. Conclusions Our results were encouraging to affirm that adherence to the ERAS program up to 75% could be considered satisfactory to get the goal. Our study could be considered a call to simplify the ERAS protocol facilitating its penetrance into clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery [3][4][5].…”

Section: Abstract Colorectal • Eras • Enhanced Recovery • Minimally I...mentioning

confidence: 99%

ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

Milone

Elmore²,

Manigrasso

et al. 2022

Surg Endosc

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“…When diagnosis of CRC is made on an outpatient basis, elective surgery can be scheduled, and the patients can be included in the ERAS pathway. In a such selected population of younger and healthier patients the surgical outcome becomes remarkable, approaching zero mortality with high laparoscopic resection rates [ 7 – 10 ]. In our series, the median age of the group of patient undergoing resection after elective hospitalization was significantly younger compared to that of the patients operated on after emergency admission (71 vs. 77 years), however, median age is still significantly higher compared to that reported in other Italian urban single center series (67 years) [ 8 , 10 ], where the incidence of patients aged less than 50 years can reach 10% [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgery remains the only potentially curative option for it, and improvements in perioperative care and surgical techniques have brought additional advances. The minimally invasive approach and the enhanced recovery after surgery (ERAS) pathway have become common practice in high volume institutions reporting remarkable surgical results in selected population of patients in urban areas in elective setting approaching zero-mortality rates [ 7 – 10 ]. However, in a larger population scale including rural (less than 300 inhabitants/km 2 ), urban (more than 1500 inhabitants/km 2 ) and ‘intermediate regions’ the overall morbidity and mortality rates remain quite high approaching 4–5%, because of higher incidence of fragile and elderly patients, and emergency clinical presentation [ 11 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring 6 years of colorectal cancer surgery in rural Italy: insights from 648 consecutive patients unveiling successes and challenges

Santoro,

Goglia,

Brighi

et al. 2024

Updates Surg

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The multidisciplinary management of patients suffering from colorectal cancer (CRC) has significantly increased survival over the decades and surgery remains the only potentially curative option for it. However, despite the implementation of minimally invasive surgery and ERAS pathway, the overall morbidity and mortality remain quite high, especially in rural populations because of urban − rural disparities. The aim of the study is to analyze the characteristics and the surgical outcomes of a series of unselected CRC patients residing in two similar rural areas in Italy. A total of 648 consecutive patients of a median age of 73 years (IQR 64–81) was enrolled between 2017 and 2022 in a prospective database. Emergency admission (EA) was recorded in 221 patients (34.1%), and emergency surgery (ES) was required in 11.4% of the patients. Tumor resection and laparoscopic resection rates were 95.0% and 63.2%, respectively. The median length of stay was 8 days. The overall morbidity and mortality rates were 23.5% and 3.2%, respectively. EA was associated with increased median age (77.5 vs. 71 ys, p < 0.001), increased mean ASA Score (2.84 vs. 2.59; p = 0.002) and increased IV stage disease rate (25.3% vs. 11.5%, p < 0.001). EA was also associated with lower tumor resection rate (87.3% vs. 99.1%, p < 0.001), restorative resection rate (71.5 vs. 89.7%, p < 0.001), and laparoscopic resection rate (36.2 vs. 72.6%, p < 0.001). Increased mortality rates were associated with EA (7.2% vs. 1.2%, p < 0.001), ES (11.1% vs. 2.0%, p < 0.001) and age more than 80 years (5.8% vs. 1.9%, p < 0.001). In rural areas, high quality oncologic care can be delivered in CRC patients. However, the surgical outcomes are adversely affected by a still too high proportion of emergency presentation of elderly and frail patients that need additional intensive care supports beyond the surgical skill and alternative strategies for earlier detection of the disease.

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“…Countries undergoing economic growth and westernization (medium HDI nations, such as Brazil, Russia, China, Latin America, the Philippines, and the Baltics) are experiencing increasing incidence of CRC. This trend reflects changes in lifestyle factors and diet: the economic development is responsible of increased consumption of red meat, fat, sugar, animal-source foods, and energy-dense food, which is associated with reduced physical activity and rising of being overweight and obese [ 46 , 47 , 48 , 49 , 50 ]. Most high-HDI nations (such as Canada, the UK, Denmark, and Singapore) have seen an increase in incidence but lowering in mortality, probably due to improved therapies.…”

Section: Incidencementioning

confidence: 99%

Colorectal Cancer: Current Updates and Future Perspectives

Marcellinaro,

Spoletini,

Grieco

et al. 2023

JCM

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Colorectal cancer is a frequent neoplasm in western countries, mainly due to dietary and behavioral factors. Its incidence is growing in developing countries for the westernization of foods and lifestyles. An increased incidence rate is observed in patients under 45 years of age. In recent years, the mortality for CRC is decreased, but this trend is slowing. The mortality rate is reducing in those countries where prevention and treatments have been implemented. The survival is increased to over 65%. This trend reflects earlier detection of CRC through routine clinical examinations and screening, more accurate staging through advances in imaging, improvements in surgical techniques, and advances in chemotherapy and radiation. The most important predictor of survival is the stage at diagnosis. The screening programs are able to reduce incidence and mortality rates of CRC. The aim of this paper is to provide a comprehensive overview of incidence, mortality, and survival rate for CRC.

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Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients

Cited by 10 publications

References 39 publications

ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

Exploring 6 years of colorectal cancer surgery in rural Italy: insights from 648 consecutive patients unveiling successes and challenges

Colorectal Cancer: Current Updates and Future Perspectives

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