Failure of enhanced recovery after surgery in laparoscopic colorectal surgery: a systematic review

Sun, Si-Da; Wu, Ping-Ping; Jun, Zhou; Wang, Jiaxing; He, Qingliang

doi:10.1007/s00384-020-03600-3

Cited by 11 publications

(6 citation statements)

References 48 publications

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“…Several studies have reported failure of ERAS even after high compliance to protocol. [17,18,19] Our study also reported an acceptable and comparable compliance to ERAS protocol elements in RCR and LCR groups and yet a difference in postoperative bowel function recovery is noted. We believe that inherent differences between RCR and LCR's, hypothesized as above, could be responsible for the different outcomes.…”

Section: Discussionsupporting

confidence: 59%

Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Mantoo

Goh

2022

Preprint

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Purpose: Our study aims to compare postoperative bowel function recovery between standard right and left sided colorectal resections and explore the need to modify ERAS protocol for right sided colonic resections.Methods: data from a prospective database of elective right colonic resections (RCR) and left colorectal resections (LCR) between January 2016 to December 2019 was analyzed. Primary outcome was to compare return of bowel function and development of post-operative ileus between RCR and the LCR groups. Secondary outcomes were length of stay, post-operative complications, 30-day re-admission, and re-operation rates.Results: Of 193 eligible patients, 72 (37.3%) were in RCR group while 171 (62.7%) were in LCR group. Laparoscopic approach was used in (41/72) 56.9% of RCR group and (90/121) 74.4% in the LCR group. Time to escalation to low residue diet was 4.29 (1-18) days in RCR vs 2.89 (1-16) days in LCR group, p=0.001. Time to flatus was 3.07 (1-12) days in RCR group and 2.44 (1-6) days in LCR group, p=0.008. 21(29.2%) patients in RCR and 16 (13.2%) in LCR groups had postoperative ileus, p=0.007. Male sex and right colonic resections were found to be significant and independent risk factors for post-operative ileus after uni- and multivariate analysis. Conclusion: Right colonic resections are associated with delayed postoperative bowel function even after high compliance with ERAS protocol. Modification of ERAS protocol elements related to postoperative feeding and addition of new interventions may help to avoid delayed bowel function recovery.

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Section: Discussionsupporting

confidence: 59%

Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Mantoo

Goh

2022

Preprint

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“…Enhanced recovery after surgery (ERAS) program achieved great success in reducing the post-operative length of stay, total complications, perioperative morbidity, and even improving 5year survival in laparoscopic colorectal surgery (7-9, 12, 13). Despite these advances, studies showed that only about a half of patients could complete post-operative recovery courses as prescribed by ERAS (9)(10)(11). Similarly, according to postoperative activity time and 6MWD, 26 patients (28.6%) who underwent laparoscopic colorectal cancer surgery could not achieve the aim of ERAS and therefore were categorized as ERAS failure group.…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for failure to comply with elements in the ERAS program were investigated and reported from several studies. These factors included demographic characteristics such as older age, male gender, and previous abdominal operation history, intraoperative factors such as more blood loss and longer operation time, and post-operative factors such as surgical complications and reoperation (11). It is important to identify and modulate risk factors to avoid deviation or failure of the ERAS program.…”

Section: Introductionmentioning

confidence: 99%

Insufficient Post-operative Energy Intake Is Associated With Failure of Enhanced Recovery Programs After Laparoscopic Colorectal Cancer Surgery: A Prospective Cohort Study

Liu

Zhang

et al. 2021

Front. Nutr.

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Background: Although enhanced recovery after surgery (ERAS) has been proven to be beneficial after laparoscopic colorectal surgery, some of the patients may fail to complete the ERAS program during hospitalization. This prospective study aims to evaluate the risk factors associated with ERAS failure after laparoscopic colorectal cancer surgery.Methods: This is a prospective study from a single tertiary referral hospital. Patients diagnosed with colorectal cancer who met the inclusion criteria were included in this study. Demographic and clinicopathological characteristics were collected. Post-operative activity time and 6-min walking distance (6MWD) were measured. Patients were divided into ERAS failure group and ERAS success according to decreased post-operative activity and 6MWD. Factors associated with ERAS failure were investigated by univariate and multivariate analysis.Results: A total of 91 patients with colorectal cancer were included. The incidence of ERAS failure is 28.6% among all patients. Patients in ERAS failure group experienced higher rate of post-operative ileus and prolonged hospital stay (p < 0.001). Multivariate analysis revealed that older age (p = 0.006), body mass index ≥25.5 kg/m2 (p = 0.037), smoking (p = 0.002), operative time (p = 0.048), and post-operative energy intake <18.5 kcal/kg•d (p = 0.045) were independent risk factors of ERAS failure after laparoscopic colorectal surgery.Conclusions: Our findings indicated that a proportion of patients may fail the ERAS program after laparoscopic colorectal surgery. We for the first time showed that post-operative energy intake was an independent risk factor for ERAS failure. This may provide evidence for further investigation on precise measurement of nutritional status and selected high-risk patients for enhanced nutrition support.

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“…Although there are guidelines for implementing an enhanced recovery protocol for colorectal surgery, variation in the number and de nition of protocol components, as well as variation in the criteria for adherence, contributes to di culties in determining which components are most important for improving patient outcomes [45][46][47]. Our results suggest that a complex surgery with an expected overall lower compliance to ERAS items should not be a deterrent to fast track application, considering the bene ts in terms of faster recovery, with no differences in terms of complications.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Outcomes of ERAS Protocol in Elective cT4 colorectal Cancer Patients. Results from a Single Center Retrospective Cohort Study.

Bellato

Cerbo

et al. 2021

Preprint

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BACKGROUND: Programs of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer. Patients presenting with more advanced disease such as T4 cancers, are frequently excluded from undergoing ERAS programs due to the difficulty in applying the whole or part of established protocols. The primary aim of this investigation was to evaluate the possibility of applying a validated ERAS protocol in patients undergoing colorectal resection for T4 colon and rectal cancer and to evaluate the short-term outcome.METHODS: Single center, retrospective cohort study. All patients with a clinical diagnosis of stage T4 colorectal cancer undergoing surgery between November 2016 to January 2020 were treated following the institutional fast track protocol without exclusion. Short-term postoperative outcomes were compared to those of a control group treated with conventional care and that underwent surgical resection for T4 colorectal cancer at the same institution from January 2010 to October 2016. Data from both groups were collected retrospectively from a prospectively maintained database. RESULTS: Eighty-two patients were diagnosed with T4 cancer, 49 patients were included in the ERAS cohort and 33 in the historical conventional care cohort. Both, the mean time of tolerance to solid food diet and postoperative length of stay, were significantly shorter in the ERAS group than in the control group (3.14±1,76 vs 4.8±1.52; p<0,0001 and 6,93±3,76 vs 9,50±4,83; p=0,0084 respectively). No differences in perioperative complications were observed.CONCLUSIONS: Results from this cohort study from a single center registry, shows that ERAS protocol is feasible also in T4 colorectal patients and enhance postoperative recovery in this group of patients.

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Failure of enhanced recovery after surgery in laparoscopic colorectal surgery: a systematic review

Cited by 11 publications

References 48 publications

Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Insufficient Post-operative Energy Intake Is Associated With Failure of Enhanced Recovery Programs After Laparoscopic Colorectal Cancer Surgery: A Prospective Cohort Study

Feasibility and Outcomes of ERAS Protocol in Elective cT4 colorectal Cancer Patients. Results from a Single Center Retrospective Cohort Study.

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