Abstract
BackgroundPrograms of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer. Patients presenting with more advanced disease such as T4 cancers are frequently excluded from undergoing ERAS programs due to the difficulty in applying established protocols. The primary aim of this investigation was to evaluate the possibility of applying a validated ERAS protocol in patients undergoing colorectal resection for T4 colon and rectal cancer and to evaluate the short-term outcome.MethodsSingle-center, retrospective cohort study. All patients with a clinical diagnosis of stage T4 colorectal cancer undergoing surgery between November 2016 and January 2020 were treated following the institutional fast track protocol without exclusion. Short-term postoperative outcomes were compared to those of a control group treated with conventional care and that underwent surgical resection for T4 colorectal cancer at the same institution from January 2010 to October 2016. Data from both groups were collected retrospectively from a prospectively maintained database.ResultsEighty-two patients were diagnosed with T4 cancer, 49 patients were included in the ERAS cohort and 33 in the historical conventional care cohort. Both, the mean time of tolerance to solid food diet and postoperative length of stay were significantly shorter in the ERAS group than in the control group (3.14 ± 1.76 vs 4.8 ± 1.52; p < 0.0001 and 6.93 ± 3.76 vs 9.50 ± 4.83; p = 0.0084 respectively). No differences in perioperative complications were observed.ConclusionsResults from this cohort study from a single-center registry support the thesis that the adoption of the ERAS protocol is effective and applicable in patients with colorectal cancer clinically staged T4, reducing significantly their length of stay and time of tolerance to solid food diet, without affecting surgical postoperative outcomes.
Highlights
Programs of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer
Even though the benefits of an enhance recovery approach can be successfully applied in most instances to colon and rectal cancer surgery, patients diagnosed with T4 colorectal cancer represent a specific subgroup, frequently composed of fragile patients, whose advanced disease may require multiorgan resections and open surgery
Study population From January 2010 to January 2020, 595 patients diagnosed with colorectal cancer underwent surgical resection at Minimally Invasive Unit of Tor Vergata Hospital, of which 105 were diagnosis with cT4 colorectal cancer
Summary
Programs of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer. ERAS is applied by a multidisciplinary team in a hospital setting, with the aim of reducing surgical stress and maintaining postoperative physiological functions [1] This approach has been shown to reduce morbidity, improve recovery, and shorten length of stay (LOS) after gastrointestinal surgery and in colorectal patients [2–6]. Even though the benefits of an enhance recovery approach can be successfully applied in most instances to colon and rectal cancer surgery, patients diagnosed with T4 colorectal cancer represent a specific subgroup, frequently composed of fragile patients, whose advanced disease may require multiorgan resections and open surgery This has historically made T4 colorectal cancer patients less suitable for ERAS protocols, due to an expected higher rate of intra and postoperative complications and reduced compliance, of both patients and caregivers. These characteristics, combined with the inapplicability of some of the ERAS principals such as no use of abdominal drains, early removal of urinary catheters, early feeding, and mobilization, are usually considered to be jeopardizing one of the principal outcomes of ERAS that is prompt discharge
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