ERAS protocol in laparoscopic surgery for colonic versus rectal carcinoma: are there differences in short-term outcomes?

Abstract

Most of the studies concerning enhanced recovery after surgery (ERAS) protocols in colorectal surgery include heterogeneous groups of patients undergoing open or laparoscopic surgery, both due to colonic and rectal cancer, thus creating a potential bias. The data investigating the differences between patients operated for either colonic or rectal cancer are sparse. The aim of the study was to compare short-term outcomes of laparoscopic surgery for colonic and rectal cancer with ERAS protocol. The analysis included consecutive prospectively registered patients operated for a colorectal cancer between January 2012 and September 2015. Patients were divided into two groups (colon vs. rectum). The measured outcomes were: length of stay (LOS), complication rate, readmission rate, compliance with ERAS protocol elements and recovery parameters (tolerance of early oral diet, mobilization and time to first flatus). Group 1 (colon) consisted of 150 patients and Group 2 (rectum) of 82 patients. Patients in Group 1 (150 patients) were discharged home earlier than in Group 2 (82 patients)—median LOS 4 versus 5 days, respectively. There was no statistical difference in complication rate (27.3 vs. 36.6 %) and readmissions (7.3 vs. 6.1 %). Compliance with the protocol was 86.9 and 82.6 %, respectively. However, in Group 1, the following procedures were used less frequently: bowel preparation (24 vs. 78.3 %) and postoperative drainage (23.3 vs. 71.0 %). There were no differences in recovery parameters between the groups. Univariate logistic regression showed that the type of surgery, drainage and stoma creation significantly prolonged LOS. In a multivariate logistic regression model, only a bowel preparation and drainage were shown to be significant. Although functional recovery and high compliance with ERAS protocol are possible irrespective of the type of surgery, laparoscopic rectal resections are associated with a longer LOS.

Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial

“…The readmission rate (<30 days) was similar in ERAS and CS groups, which indicated that the scientific discharge criteria in ERAS programs would not increase the readmission rate. The results of RCT were consistent with the research of ERAS protocol in laparoscopic colorectal surgery by Pędziwiatr et al …”

“…As the morbidity rate of overall complications decreased in ERAS group after implementing the ERAS programs, which proved that ERAS programs can safely reduce surgical stress and accelerate patient recovery. We can see that compared with CS group, the patients in ERAS group had low peak of WBCs and ALT,also had higher number of ALB in postoperative days, which Pędziwiatr et al [20][21][22][23] The advantages of ERAS concept manifest in more adequate preoperative preparation before surgery. The detailed preoperative education can reduce patient anxiety through communication.…”

Prolonged hospital stay and readmission rate in an enhanced recovery after surgery cohort undergoing colorectal cancer surgery

“…A study investigating which patients would fail early discharge following laparoscopic colorectal cancer found intra‐operative complications and a longer duration of surgery to increase the risk of LOS > 4 days . A further study found mechanical bowel preparation and peritoneal drainage significantly associated with prolonged hospital stay in patients with colorectal cancer, something we did not study .…”

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

“…Pędziwiatr [46] investigated if there were differences in short-term outcomes between laparoscopic surgery for colonic and rectal carcinoma, in the context of an ERAS program and concluded that LOSH was significantly lower for patients treated for colonic cancer than for those treated for rectal cancer (median LOSH: 4 vs. 5; p<0.0464). No statistical difference was found in postoperative complications between groups, nor in the 30-day readmission rates.…”