ERAS Protocol Reduces IL-6 Secretion in Colorectal Laparoscopic Surgery: Results From a Randomized Clinical Trial

Mari, Giulio; Crippa, Jacopo; Costanzi, Andrea; Mazzola, Michele; Rossi, Michele; Maggioni, Dario

doi:10.1097/sle.0000000000000324

Cited by 34 publications

(29 citation statements)

References 17 publications

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“…CRP showed the same pattern as IL-6, being lower as close as 2 hours after surgery (23) till POD 7 (17,22). Only two authors investigated the stress response dosing pituitary and adrenal hormones (16,20). Table 3 reports statistically significant results.…”

Section: Authormentioning

confidence: 84%

“…Results Five studies regarded patients undergoing colorectal surgery (16,(18)(19)(20)(21), one study gastric surgery (17), one study cystectomy (22) and one study retroperitoneal adrenalectomy (23). Three papers reported nutritional and immune function evaluation (17,19,20), two papers compared the differences in stress hormones response (16,20). Three papers investigated surgical impact in terms of humoral response measuring HLA-DR expression on monocyte, Immunoglobulin (Ig) or lymphocyte subpopulations (16,18,19).…”

Section: Resultsmentioning

confidence: 99%

“…Mari et aldescribedthe largest series of cases (140 patients) equally divided between ERP and standard care. They reported significant lower IL-6 for enhanced patients on POD 1, 3 and 5 along with return to baseline from POD 3 (20). No significant difference was found between groups when cortisol and prolactin were dosed.…”

Section: Authormentioning

confidence: 92%

“…Studies investigating nutritional status showed better outcomes for patients undergoing ERP. Mari et al (20) described higher prealbumin levels along with return to preoperative values on POD 5. Similar results were described by Liu et al (17).…”

Section: Authormentioning

confidence: 96%

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Surgical Stress Response and Enhanced Recovery after Laparoscopic Surgery - A systematic review

Crippa¹,

Mari²,

Miranda³

et al. 2018

chr

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Enhanced Recovery Program (ERP) is a multimodal perioperative protocol. Its feasibility and benefits on short term outcomes have been widely reported. These well described improvements, like shorter length of stay and early resumption of body's functions, represent the consequence of an attenuated surgical stress response (SSR). When this response is uncontrolled, it leads to postoperative complications and poor long-term outcomes. SSR can be easily monitored through the analyses of mediators in the bloodstream. Available evidences do not achieve to tell if ERP allows a measurable surgical stress reduction. In this review, we searched for papers investigating the surgical stress response and ERP applied to elective mini-invasive procedures, in order to better understand the level of evidence regarding the effectiveness of ERP in minimizing the surgical stress response. A systematic review of published literature was performed using PubMed, Cochrane, EMBASE and Google Scholar database, following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Included studies concerned SSR analysis in ERP patients undergoing laparoscopic surgery through different surgical specialties. Eight studies with a total of 632 patients were included. The three steps of SSR, endocrine, inflammatory and nutritional were all reported in the papers included in this review. Results showed no powerful evidence of difference in endocrine phase while an attenuated inflammatory response was reported for ERP patients when Interleukin-6 (IL-6) and C Reactive Protein (CRP) were dosed. Nutritional status was also preserved as albumin, pre-albumin and transferrin had better values in these patients. ERP applied to different types of laparoscopic surgery has a role in reducing SSR. This can be shown by the analysis of mediators such as IL-6, CRP and nutritional markers.

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Section: Authormentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: Authormentioning

confidence: 92%

Section: Authormentioning

confidence: 96%

See 2 more Smart Citations

Surgical Stress Response and Enhanced Recovery after Laparoscopic Surgery - A systematic review

Crippa¹,

Mari²,

Miranda³

et al. 2018

chr

Self Cite

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“…In a RCT, Mari et al [33] demonstrated that the ERAS protocol, applied to colorectal laparoscopic procedures, reduces the surgical stress response by diminishing levels of important proinflammatory elements, more specifically IL-6 and C-reactive protein. This attenuates the liver's protein synthesis switch from physiological to acute phase inflammatory proteins, allowing for an earlier liver function resumption.…”

Section: Colorectal Surgerymentioning

confidence: 99%

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Tintim¹,

Machado²

2017

J Anesth Clin Res

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Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer

Quiram

Crippa

Grass

et al. 2019

British Journal of Surgery

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Background: Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer. Methods: This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care.Results: A total of 600 patients underwent minimally invasive surgery, of whom 320 (53⋅3 per cent) were treated according to the ERP and 280 (46⋅7 per cent) received conventional care. ERP was associated with less overall morbidity (34⋅7 versus 54⋅3 per cent; P < 0⋅001). Patients in the ERP group had improved overall survival on univariable (91⋅4 versus 81⋅7 per cent at 5 years; hazard ratio (HR) 0⋅53, 95 per cent c.i. 0⋅28 to 0⋅99) but not multivariable (HR 0⋅78, 0⋅41 to 1⋅50) analysis. Multivariable analysis revealed age (HR 1⋅46, 1⋅17 to 1⋅82), male sex (HR 1⋅98, 1⋅05 to 3⋅70) and complications (HR 2⋅23, 1⋅30 to 3⋅83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80⋅5 versus 84⋅6 per cent at 5 years respectively; P = 0⋅272).Conclusion: Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.

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ERAS Protocol Reduces IL-6 Secretion in Colorectal Laparoscopic Surgery: Results From a Randomized Clinical Trial

Abstract: ERAS protocol applied to colorectal laparoscopic surgery affects surgical stress response, decreasing IL-6 and CRP levels postoperatively and improving prealbumin postoperative synthesis.

Cited by 34 publications

References 17 publications

Surgical Stress Response and Enhanced Recovery after Laparoscopic Surgery - A systematic review

Surgical Stress Response and Enhanced Recovery after Laparoscopic Surgery - A systematic review

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer

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