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

Abstract

Background Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted. Methods The Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: “ERAS” or “enhanced recovery” or “fast track”, “oncologic outcome”, “recurrence”, “metastasis”, “long-term outcomes”, “survival”, and “cancer surgery”. The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed. Results A total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy. Conclusions The use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival.

ERAS Protocol Applied to Oncological Colorectal Mini-invasive Surgery Reduces the Surgical Stress Response and Improves Long-term Cancer-specific Survival

“…A recent review by Pang and colleagues highlighted that the use of ERAS in cancer surgery can improve the on-time initiation and completion of adjuvant chemotherapy after surgery. However, they concluded that up to now it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival 17…”

Effects of the Enhanced Recovery After Surgery (ERAS) Program for Colorectal Cancer Patients Undergoing Laparoscopic Surgery

“…In contrast, the ERAS program is actively used in surgeries, such as treatment of biliary pancreatic acid, thyroid disease, pediatric surgery, and vascular surgery. However, the ERAS program is only used in very limited fields in Korea, with no recent research [ 15 16 ]. Therefore, this study was conducted as a pilot study to develop a standardized ERAS program for colon cancer surgical patients and to improve patient recovery.…”

Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: propensity score matching analysis of 169 cases

“…MIE was introduced to decrease the significant perioperative morbidity and mortality caused by OE [ 12 , 32 ]. Several previous studies have demonstrated that MIE could significantly improve perioperative outcomes of EC; however, limitations existed in some of them, such as selection bias and data heterogeneity [ 22 , 33 – 35 ]. The only level I evidence came from a recent multicentre randomised clinical trial [ 36 – 38 ].…”