Implementation of enhanced recovery after surgery and its increasing compliance improved 5-year overall survival in resectable stage III colorectal cancer

Lohsiriwat, Varut; Lertbannaphong, Sarinda; Polakla, Bundhawich; Riansuwan, Woramin

doi:10.1007/s13304-021-01004-8

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…Interesting, recent evidence has supported a multimodal approach to post-hemorrhoidectomy pain, e.g., a combination of flavonoids and oral metronidazole had a greater degree of pain reduction after hemorrhoidectomy than either single medication [ 93 ]. Moreover, increased adherence to guideline recommendations or surgical care bundles was associated with better short-term and long-term surgical outcomes [ 94 , 95 ]. Whether multimodal approaches to post-hemorrhoidectomy pain and their adherence would result in better pain relief needs to be investigated.…”

Section: Resultsmentioning

confidence: 99%

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Lohsiriwat

Jitmungngan

2022

Medicina

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Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results:Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.

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Section: Resultsmentioning

confidence: 99%

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Lohsiriwat

Jitmungngan

2022

Medicina

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“…Our findings align with previous studies that have shown improved survival rates associated with ERAS. Lohsiriwat et al 16 conducted a similar cohort study and showed ERAS was associated with improved survival among a subgroup of patients with stage III cancer. Additionally, high compliance (>70%) with an ERAS program has been correlated with better 5‐year survival rates in advanced stages of cancer, 11,16 but not at 3 years of study follow‐up 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Lohsiriwat et al conducted a similar cohort study and showed ERAS was associated with improved survival among a subgroup of patients with stage III cancer. 13 Additionally, high compliance (>70%) with an ERAS program has been correlated with better 5-year survival rates in advanced stages of cancer, 12,13 but not at 3-years of study follow up. 11 Quiram et al 10 found a statistically signi cant association between ERAS and overall survival, but no relationship was detected for disease-free survival.…”

Section: Discussionmentioning

confidence: 99%

“…9,13 Unfortunately, the evidence regarding management associated with an ERAS program and cancer recurrence is still inconclusive, with a handful of studies yielding inconsistent results about the impact on survival. 11,[14][15][16] Our group aimed to determine the association between an ERAS program for colorectal surgery and long-term cancer recurrence and survival. through March 2016 (ERAS group).…”

Section: Introductionmentioning

confidence: 99%

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Association between enrollment in an enhanced recovery program for colorectal cancer surgery and long‐term recurrence and survival

Zorrilla-Vaca

Ripollés‐Melchor

Abad‐Motos

et al. 2022

Journal of Surgical Oncology

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“…The remainder of baseline demographic and clinical characteristics were comparable between periods (Table 1). Patients enrolled in the ERAS program had shorter surgical times (119 vs. 140 minutes, P<0.01), received more total intravenous anesthetics (TIVA; 24.7 vs. 13…”

Section: Patient Characteristicsmentioning

confidence: 99%

Association Between Enrollment in an Enhanced Recovery Program for Colorectal Cancer Surgery and Long-Term Recurrence and Survival

Zorrilla-Vaca¹,

Ripollés‐Melchor²,

Abad‐Motos³

et al. 2021

Preprint

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IntroductionEnhanced Recovery After Surgery (ERAS) programs have been shown to minimize the surgical inflammatory response in colorectal cancer, leading to early patient recovery and better postoperative outcomes. Our objective was to determine the association between an ERAS program for colorectal cancer surgery and oncologic recurrence and survival.MethodsA before-after intervention study was designed including patients who underwent colorectal cancer surgery between November 2010 and March 2016. During the study period the institutional criteria for adjuvant therapy remained unchanged and all patients were followed up for 5 years. Cox hazard regression analysis was performed per cumulative year of follow up to evaluate the association between ERAS program exposure and overall survival, cancer-related mortality, and oncologic recurrence. Subgroup analysis was performed by cancer stage (low [I/II] vs advanced [III/IV]).ResultsIn total, 612 patients were included, of which 321 were pre-ERAS and 291 ERAS. Our overall median compliance rate with ERAS interventions was 90% (IQR 85%-95%). Overall survival rates were higher in the ERAS group within the first 2-years after surgery (89.2% vs 83.2%, P=0.04), but there was no difference at 5-year follow up (73.3% vs 72.5%, P=0.82). Subgroup analysis revealed the ERAS enrollment was associated with a significantly lower risk in 5-year oncologic recurrence (aHR 0.55, 95%CI 0.33-0.94, P=0.03) and higher 4-year survival (aHR 0.59, 95%CI 0.37-0.93, P=0.02) among patients with advanced cancer stage compared to pre-ERAS counterparts. ConclusionsPatients with advanced colorectal cancer were less likely to suffer oncologic recurrence when managed during the ERAS period. Additional prospective trials are necessary to determine causation and identify best practice principles associated with long-term recurrence and survival.

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Implementation of enhanced recovery after surgery and its increasing compliance improved 5-year overall survival in resectable stage III colorectal cancer

Cited by 17 publications

References 26 publications

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Association between enrollment in an enhanced recovery program for colorectal cancer surgery and long‐term recurrence and survival

Association Between Enrollment in an Enhanced Recovery Program for Colorectal Cancer Surgery and Long-Term Recurrence and Survival

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