Five-year oncological outcomes after enhanced recovery after surgery (ERAS) compared to conventional care for colorectal cancer: a retrospective cohort of 981 patients.

Abstract

The enhanced recovery after surgery (ERAS) protocol has been introduced over the past three decades for patients undergoing colorectal surgery. However, the effect of this program on long-term survival is poorly studied. We evaluated the effect of ERAS on 5-year overall survival (OS) and recurrence-free survival (RFS) after colorectal cancer surgery, and identified risk factors. This retrospective study used data from the comparison of oncological outcomes at 3years after ERAS or conventional care (pre-ERAS), conducted in our department between 2005 and 2017, and published in 2022. A total of 981 patients were included (ERAS, n = 486; pre-ERAS, n = 495). The 5-year OS and RFS rates were similar in the ERAS and pre-ERAS groups, respectively (63.3% [58.9;67.4] vs 57.7% [53.2;61.9]; p = 0.055) and (69.5% [65.2;73.4] vs 70.9% [66.6;74.8]; p = 0.365). The 5-year OS result was confirmed by a propensity score analysis (HR0.98 [0.71; 1.37], p = 0.911). Analysis of 5-year survival by a multivariate Cox model identified age (HR1.28 [1.15; 1.43]), BMI < 18.5 (HR1.62 [1.08;2.45]), smoking (HR1.68 [1.26;2.24]), ASA score > 2 (HR1.56 [1.22;1.98]), and laparotomy interventions (HR2.06 [1.61;2.63]) as risk factors for death. Regarding RFS, multivariate analysis adjusted on the ERAS group identified age as a protective factor with a reduction of 10% in the risk of recurrence (HR0.90 [0.81-0.99]). In contrast patients treated with neoadjuvant chemotherapy had a higher risk of recurrence (HR1.41 [1.07-1.85]). This study failed to demonstrate any advantage of the ERAS program in improving 5-year OS and RFS after colorectal cancer surgery. Age, undernutrition, smoking, ASA score > 2, and laparotomy interventions are independently associated with early mortality.