The impact of compliance with Enhanced Recovery After Surgery (ERAS) protocol on short and long-term outcomes in patients after laparoscopic colorectal cancer surgery

Abstract

Patients undergoing surgery for colorectal cancer are a special group of patients. Not only performed resections are extensive, but also the underlying disease significantly depletes regenerative capacities of the body. It is well known that every surgical procedure is associated with an injury, the size of which is proportional to the type and extent of the intervention. The size of surgical trauma in postoperative period is proportional to the increase in insulin resistance which delays convalescence and increases the risk of postoperative complications. Hence, for several years, a specific program had been developed and introduced to reduce trauma associated with the surgery and its adverse consequences. The use of a modern multimodal care protocol for Enhanced Recovery After Surgery(ERAS) served this purpose. The aim of the study was to determine the impact of compliance to ERAS protocol on short-term results in a group of patients operated for colorectal cancer. In the next stage, it was checked whether it is possible to maintain high compliance of the protocol for a long time. Finally, I tried to determine the relationship between the compliance and distant oncological results. Consecutive patients with colon or rectal cancer undergoing laparoscopic resection were included in the study. In all patients the 16-item ERAS protocol was applied. The use of ERAS protocol improves short-term results: accelerates convalescence, reduces morbidity and reduces the length of hospital stay. However, its impact on short-term results correlates with the level of protocol implementation. The higher compliance with the protocol, the better the short-term results. Maintaining a high level of implementation of the protocol is possible despite the slight decrease over time. However, this has no adverse effect on short-term results. The compliance with ERAS protocol seems to also affect long-term results. Low compliance with ERAS protocol, along with the higher stage of cancer and postoperative complications, is an independent factor worsening long-term survival.