Retrospective analysis of safety and efficacy of enhanced recovery pathways in stage II–III colorectal cancer patients submitted to surgery and adjuvant therapy

Abstract

Background The American Society of Colon and Rectal Surgeons is suggesting laparoscopic surgeries for colorectal cancer. Conventional perioperative procedures like long preoperative fasting and bowel procedures are not useful and harmful to patients undergoing surgeries for colorectal cancer. The objectives of the study were to compare surgery outcomes, hospital stays, and survival of patients who received fast-track (laparoscopy/open) surgical procedure followed by chemotherapy against those who received conventional (laparoscopy/open) surgical procedure followed by chemotherapy for colorectal cancer. Methods The study analyzes the outcomes of a total of 542 colorectal cancer (preoperative biopsies stage II or III) patients submitted to surgery and adjuvant chemotherapy. The study cohort is retrospectively subdivided in 4 groups submitted to open or laparoscopic resection with or without fast-track protocol appliance and two different chemotherapy regimens. Patients who ended up being TNM stage I have not received the adjuvant chemotherapy. Results The fast-track surgical procedure had shorter total hospital stays and postoperative hospital stays than the conventional surgical procedures. Flatus resumption time, the time until first defecation, and intraoperative blood loss were shorter for the fast-track surgical procedures than the conventional surgical procedures. Those surgery outcomes were also shorter for the fast-track laparoscopy than the open fast-track. Resumption of a fluid diet and ambulation onset time were shorter for the fast-track surgical procedures than the conventional surgical procedures. The surgical checkpoints that were compliance by patient of fast-track surgeries were significantly fewer than those of the conventional surgeries. Clinically significant difference for QLQ-C30/CR38 score after chemotherapy was reported between patients who received open conventional surgeries and those patients who received fast-track laparoscopy (59.63 ± 2.26 score/patient vs. 71.67 ± 5.19 score/patient). There were no significant differences for the number of patients with any grade adverse effects (p = 0.431) or with grade 3–4 adverse effects (p = 0.858), and the disease-free and overall survival among cohorts. Conclusions The fast-track surgical procedure is effective and safe even in a multidisciplinary scenario as colorectal cancer treatment in which surgery is only a part of management. Level of evidence: III Technical efficacy stage: 4.

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

“…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 .…”

“…The elements of the ERAS protocol in each article are presented in Table 2 . The number of ERAS elements in the included articles ranged from 3 to 18, and 17 articles described a protocol containing more than 10 elements [ 11 , 13 – 18 , 21 , 22 , 24 , 26 , 27 , 29 , 30 , 32 – 34 ].…”

“…Twelve studies [ 10 – 14 , 16 , 29 – 34 ] reported long-term overall survival (OS), and the follow-up time ranged from 10 months to 10 years. Four studies [ 14 , 31 , 33 , 34 ] showed ERAS was associated with increasing long-term OS, while the others found no differences between conventional care and ERAS.…”

“…Three studies reported long-term cancer-specific survival (CSS) [ 11 , 12 , 33 ], and 4 studies reported long-term disease-free survival (DFS) [ 16 , 29 – 31 ].The follow-up time ranged from 10 months to 10 years, 1 study showed that ERAS could improve CSS [ 33 ] and DFS [ 30 ], while the others found no differences. One study [ 31 ] reported recurrence and metastasis, the result found no difference between conventional care and ERAS.…”

“…Four studies reported the effect of altering one single item within the ERAS protocol on long-term survival and local recurrence [ 27 – 29 , 35 ]. The follow-up time ranged from 10 months to 5 years.…”