IMPLEMENTATION OF ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS WITH COLORECTAL CANCER AND CONCOMITANT METABOLIC SYNDROME

Abstract

Introduction. Implementation of enhanced recovery after surgery protocol (ERAS) is becoming more and more widespread due to their effectiveness and safety. At the same time, there is a rather limited number of studies focusing on the opportunities of ERAS in the context of its association with metabolic syndrome in patients with colorectal cancer. This study represents the results of our early experience implementing elements of the ERAS program in the perioperative management of patients with colorectal cancer associated with metabolic syndrome.
 The aim. To conduct a comparative analysis and evaluate the results of surgical treatment using the enhanced recovery after surgery protocol in patients with colorectal cancer and accompanying metabolic syndrome.
 Materials and methods. This study included 106 patients with colorectal cancer and accompanying metabolic syndrome, divided into two groups: the first group with the use of elements of the ERAS protocol in colorectal surgery from 2018 – 56 patients, and the second group in which the principles of ERAS were not used (50 patients).
 Results. In the first group, with a statistically significant difference, a less severe pain syndrome was observed according to VAS (p<0.001), as well as a lower necessity for prescribing opioid analgesics in the postoperative period. Activation of patients, restoration of enteral nutrition and peristalsis occurred earlier in first group (p<0.001).
 Mean hospital stay in the first group was 5.7±1.5 days, and in second group – 7.7±1.7 days (p<0.001). In the 2nd group, the percentage of complications such as: postoperative wound seroma, abdominal organ eventration, and anastomotic leaks in the 30-day postoperative period were higher than in the group with ERAS elements included.
 Conclusion. The implementation of elements from the Enhanced Recovery After Surgery (ERAS) protocol for the treatment of patients with colorectal cancer and concomitant metabolic syndrome is effective and safe. It is associated with a decreased duration of hospitalization, less postoperative pain, earlier return to enteral nutrition, quicker patient mobilization, and restoration of peristalsis. Additionally, it reduces the frequency of postoperative complications and readmission rates.