Does enhanced recovery improve the survival rates of patients 3 years after undergoing surgery to remove a tumor in the colon?

Abstract

Purpose The advantages of enhanced recovery programs (ERP) after colorectal surgery for morbidity and length of stay are well known. On a longer term, evidence is much more limited. The aim of this study is to determine the impact of ERP on survival after 3 years of follow-up, following colorectal cancer surgery. Methods All the patients undergoing resection for colorectal cancer between the years 2010 and 2014 were included. Patients were classified according to their compliance with the ERP (< 70 or ≥ 70%). Results Among the 206 patients included during the period, 129 were male (62.6%). The 3-year overall survival rate was 70.4% (145 patients) and relapse-free survival was 59.2% (122 patients). The survival after 3 years was influenced by the initial metastatic status (p < 0.0001), operative morbidity (p < 0.001), and the presence of peritumoral emboli (p = 0.006). However, the compliance with the ERP ≥ 70% did not influence overall survival (p = 0.63), nor relapse-free survival (p = 0.93). The same observations were found among the Bat-risk^population (synchronous metastasis and postoperative complication). Conclusion The ERP does not seem to influence the 3-year relapse-free survival after colorectal resection for cancer.

Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries — a systematic review

“…Of these 26 articles, 3 were randomized trials [ 12 , 13 , 15 ], which were evaluated by Jadad score, and the other 23 were prospective or retrospective cohort studies, which were evaluated by the NOS. Eighteen articles compared conventional care with ERAS [ 10 – 21 , 29 – 34 ], 7 studies compared high adherence to ERAS with low adherence [ 16 , 22 – 26 , 34 ], and 4 studies [ 27 – 29 , 35 ] investigated the outcome of one single item altered within ERAS protocol. The elements of the ERAS protocol in each article are presented in Table 2 .…”

“…The elements of the ERAS protocol in each article are presented in Table 2 . The number of ERAS elements in the included articles ranged from 3 to 18, and 17 articles described a protocol containing more than 10 elements [ 11 , 13 – 18 , 21 , 22 , 24 , 26 , 27 , 29 , 30 , 32 – 34 ].…”

“…The outcomes and findings of the included studies are displayed in Table 3 . Seventeen studies described oncologic outcomes [ 11 , 12 , 16 – 23 , 25 , 28 – 31 , 33 , 35 ], and 20 studies described long-term outcomes [ 10 – 16 , 22 – 34 ].…”

“…Seven studies compared high adherence to ERAS and low adherence to ERAS [ 16 , 22 – 26 , 34 ]. Long-term OS was reported in six studies, and the follow-up time ranged from 2 to 5 years.…”

“…Long-term OS was reported in six studies, and the follow-up time ranged from 2 to 5 years. Half of the studies showed no differences in OS between high and low adherence [ 16 , 22 , 26 ], and half showed improvements in OS by high adherence to ERAS [ 23 , 24 , 34 ]. Two studies reported DFS [ 16 , 25 ]; one showed that high adherence to ERAS could improve 3-year DFS [ 25 ], and the other did not find any difference [ 16 ].…”