Gastrointestinal cancer surgery and enhanced recovery after surgery (ERAS) during COVID-19 outbreak

Sica, Giuseppe; Campanelli, Michela; Bellato, Vittoria; Monteleone, Giovanni

doi:10.1007/s00423-020-01885-0

Cited by 23 publications

(21 citation statements)

References 5 publications

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“…Another cornerstone in CD surgery was represented by the advent of minimally invasive surgery. Feasibility and safety of laparoscopic ileo-cecal resection has been assessed and it was found not inferior in terms of outcomes when compared to open surgery [ 53 – 55 ]. Nowadays, laparoscopy is largely accepted as the first line approach for CD, in the presence of adequate expertise [ 56 ].…”

Section: Surgical Management and CD Recurrencementioning

confidence: 99%

Pathophysiology of Crohn’s disease inflammation and recurrence

et al. 2020

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Chron’s Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which inflammation plays a key role. Crohn’s disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a TH1 response, through the production of cytokines such as IL-12 and TNF-α. IL-12 itself and IL-23 have been targeted for the medical treatment of CD. Giving the limited success of medical therapies, the treatment of the disease is invariably surgical. This review will highlight the role of inflammation in CD and describe the surgical approaches for the prevention of the almost inevitable recurrence.

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Section: Surgical Management and CD Recurrencementioning

confidence: 99%

Pathophysiology of Crohn’s disease inflammation and recurrence

et al. 2020

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“…Only two articles discussed the utility and effect of ERAS protocols during the COVID-19 pandemic for gynecologic oncology 11 and gastrointestinal cancer surgery. 12 Due to the paucity of literature regarding this topic, we were unable to perform a systematic review of the literature but instead provide a narrative review on the aspects of ERAS and how it can potentially benefit patients and health care systems when performing arthroplasty in a pandemic.…”

Section: Review Of Literaturementioning

confidence: 99%

Enhanced Recovery after Surgery for Knee Arthroplasty in the Era of COVID-19

Ding

Tan

2020

J Knee Surg

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Enhanced recovery after surgery (ERAS) represents a paradigm shift in perioperative care, aimed at achieving early recovery for surgical patients, reducing length of hospital stay, and complications. The purpose of this study was to provide an insight of the impact of the COVID-19 on ERAS protocols for knee arthroplasty patients in a tertiary hospital and potential strategy changes for postpandemic practice. We retrospectively reviewed all cases that underwent surgery utilizing ERAS protocols in the quarter prior to the pandemic (fourth quarter of 2019) and during the first quarter of 2020 when the pandemic started. A review of the literature on ERAS protocols for knee arthroplasty during the COVID-19 pandemic was also performed and discussed. A total of 199 knee arthroplasties were performed in fourth quarter of 2019 as compared with 76 in the first quarter of 2020 during the COVID-19 outbreak. Patients who underwent surgery in the first quarter of 2020 had shorter inpatient stays (3.8 vs. 4.5 days), larger percentage of discharges by postoperative day 5 (86.8 vs. 74.9%), and a larger proportion of patients discharged to their own homes (68 vs. 54%). The overall complication rate (1.3 vs. 3%) and readmission within 30 days (2.6 vs. 2%) was similar between both groups. ERAS protocols appear to reduce hospital lengths of stay for patients undergoing knee arthroplasty without increasing the risk of short-term complications and readmissions. The beneficial effects of ERAS appear to be amplified by and are synchronous with the requirements of operating in the era of a pandemic.

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“…The impact of pandemic on the standards of care and the care particularly related to the ERAS pathways is yet to be ascertained. No institutions have made or suggested any modifications to the ERAS pathways that were implemented during the pandemic [2][3] .…”

Section: Editormentioning

confidence: 99%

“…avoidance of minimal access surgery etc. ), some reports have suggested that the standard ERAS pathway was COVID safe 2 . It was also recognised that the implementation of ERAS elements was more efficient during this time 2 .…”

Section: Editormentioning

confidence: 99%

“…), some reports have suggested that the standard ERAS pathway was COVID safe 2 . It was also recognised that the implementation of ERAS elements was more efficient during this time 2 . This could perhaps be explained owing to the particular consciousness of the caregivers and patients in minimising the length of stay and thereby reducing the risk of nosocomial viral infection.…”

Section: Editormentioning

confidence: 99%

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