Abstract
IntroductionEnhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery. However, despite the benefits of the ERAS program on short-term results, little is known about its impact on long-term results.ObjectiveThe aim of the study was to determine the association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer.Material and MethodologyBetween 2013 and 2016, 350 patients underwent laparoscopic colorectal cancer resection in the 2nd Department of General Surgery, Jagiellonian University Medical College, and were enrolled for further analysis. The relationship between the rate of compliance with the ERAS protocol and 3-year survival was analyzed according to the Kaplan–Meier method with log-rank tests. Patients were divided into two groups according to their degree of adherence to the ERAS interventions: Group 1 (109 patients), < 80% adherence, and Group 2 (241 patients), ≥ 80% adherence. The primary outcome was overall 3-year survival. The secondary outcomes were postoperative complications, length of hospital stay, and recovery parameters.ResultsThe groups were similar in terms of demographics and surgical parameters. The median compliance to ERAS interventions was 85.2%. The Cox proportional model showed that AJCC III (HR 3.28, 95% CI 1.61–6.59, p = 0.0021), postoperative complications (HR 2.63, 95% CI 1.19–5.52, p = 0.0161), and compliance with ERAS protocol < 80% (HR 3.38, 95% CI 2.23–5.21, p = 0.0102) were independent predictors for poor prognosis. Additionally, analysis revealed that adherence to the ERAS protocol in Group 2 with ≥ 80% adherence was associated with a significantly shorter length of hospital stay (6 vs. 4 days, p < 0.0001), a lower rate of postoperative complications (44.7% vs. 23.3%, p < 0.0001), and improved functional recovery parameters: tolerance of oral diet (53.4% vs. 81.5%, p < 0.0001) and mobilization (77.7% vs. 96.1%, p < 0.0001) on the first postoperative day.Conclusions and RelevanceThis study reports an association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. Lower adherence to the protocol, independent from stage of cancer and postoperative complications, was an independent risk factors for poorer survival rates.
Highlights
Enhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery
The Cox proportional model showed that AJCC III (HR 3.28, 95% confidence intervals (CI) 1.61–6.59, p = 0.0021), postoperative complications (HR 2.63, 95% CI 1.19–5.52, p = 0.0161), and compliance with ERAS protocol \ 80% (HR 3.38, 95% CI 2.23–5.21, p = 0.0102) were independent predictors for poor prognosis
Analysis revealed that adherence to the ERAS protocol in Group 2 with C 80% adherence was associated with a significantly shorter length of hospital stay (6 vs. 4 days, p \ 0.0001), a lower rate of postoperative complications (44.7% vs. 23.3%, p \ 0.0001), and improved functional recovery parameters: tolerance of oral diet (53.4% vs. 81.5%, p \ 0.0001) and mobilization (77.7% vs. 96.1%, p \ 0.0001) on the first postoperative day
Summary
Enhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery. Several previous studies have shown that compliance with the ERAS protocol is strongly correlated with short-term outcomes, such as postoperative complications, readmission rate, and shortened length of hospital stay [10,11,12,13]. An increase in compliance to the ERAS protocol from high to very high/complete has been associated with further improvement in short-term outcomes [14] This is important because large data suggest that postoperative complications may have an impact in the short term, but may affect long-term life expectancy [15]. One in elective orthopedic surgery and another following elective open colorectal cancer surgery, reported that the introduction of ERAS principles was associated with improved long-term survival [11, 16]. The aim of this study was to analyze whether the level of adherence with the ERAS protocol had any impact on long-term survival after laparoscopic colorectal resection for cancer
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