Compliance with the ERAS Protocol and 3‐Year Survival After Laparoscopic Surgery for Non‐metastatic Colorectal Cancer

Abstract

Introduction 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. However, despite the benefits of the ERAS program on short-term results, little is known about its impact on long-term results.Objective The aim of the study was to determine the association between adherence to the ERAS protocol and longterm survival after laparoscopic colorectal resection for non-metastatic cancer. Material and Methodology Between 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), C 80% adherence. The primary outcome was overall 3-year survival. The secondary outcomes were postoperative complications, length of hospital stay, and recovery parameters. Results The 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 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. Conclusions and RelevanceThis study reports an association between adherence to the ERAS protocol and longterm 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. & Michał Pędziwiatr Hypertension, n (%) 53 (48.6%) 119 (49.4%) 0. 8961 Diabetes, n (%) 23 (21.1%) 38 (15.8%) 0. 2232 Pulmonary disease, n (%) 11 (10.1%) 20 (8.3%) 0. 5846 Renal disease, n (%) 8 (7.3%) 14 (5.8%) 0. 5849 Formation of stoma 23 (21.1%) 66 (27.4%) 0. 2112 Median operative time, min. (IQR) 180 (140-240) 190 (160-230) 0.7148 Median intraoperative blood loss, mL (IQR) 100 (50-100) 100 (50-150) 0.7797 Conversion, n (%) 5 (4.6%) 7 (2.9%) 0. 4231 Need for blood transfusion, n (%) 9 (8.3%) 21 (8.7%) 0.8876 Colon, n (%) 71 (65.1%) 155 (64.3%) 0.8816 Rectum, n (%) 38 (34.9%) 86 (35...

Opportunities for Quality Improvement Programs (QIPs) in the Nutrition Support of Patients with Cancer

“…ERAS ® is not a single, rigid protocol but rather a comprehensive new way for multidisciplinary teamwork to make changes as knowledge evolves [ 51 ]. ERAS ® includes a significant nutrition component and ERAS ® has been shown to decrease complications, reduce LOS, and save costs for oncology patients undergoing surgery [ 52 , 53 , 54 ]. Another recommendation to incentivize more comprehensive care is for healthcare organizations to advocate for the addition of malnutrition care to future updates of the OCM.…”

Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice

“…To date, this is not the case with many studies demonstrating that, with increasing compliance to ERAS, improved outcomes are seen (decreased length of stay and complications) and without increased re-admission rates. [31][32][33] Furthermore, increasing ERAS compliance has been shown to be associated with improved survival in colorectal surgery 34 and orthopedics. 35 The major strength of this study is that it is the first to be conducted on a global scale, including over 454 respondents from 62 countries.…”

A Protocol is not Enough: Enhanced Recovery Program‐Based Care and Clinician Adherence Associated with Shorter Stay After Colorectal Surgery

“…Evidence on the impact of the ERP on mortality is mixed. Large, non-randomised series have reported an association between greater ERP adherence and reduced long-term mortality rates [27,28]. However, data from meta-analyses of randomised trials report that the ERP is not significantly associated with reduced mortality rates [1][2][3].…”