The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery – A prospective cohort study within an ERAS protocol

Asklid, Daniel; Segelman, Josefin; Gedda, Claes; Hjern, Fredrik; Pekkari, Klas; Gustafsson, Ulf

doi:10.1016/j.ejso.2017.04.003

Cited by 65 publications

(53 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The ERAS protocol, designed to reduce surgical stress, has in previous studies been shown to improve short-term postoperative recovery (morbidity/LOS) in Table 2 Overall pre-and intra-operative compliance to the Enhanced Recovery After Surgery (ERAS) protocol (12 items both open and laparoscopic colorectal surgery [16,17,[23][24][25][26]. Recently published data also suggest that the ERAS protocols may have positive effects on long-term outcome, as measured by 5-year survival [14,15]. The ERAS programme aims to standardize evidence-based perioperative interventions.…”

Section: Discussionmentioning

confidence: 99%

Robotic vs laparoscopic rectal tumour surgery: a cohort study

et al. 2018

Self Cite

View full text Add to dashboard Cite

Aim The aim of this study was to compare robotic and laparoscopic rectal surgery in terms of perioperative data, short‐term outcome and compliance to the Enhanced Recovery After Surgery (ERAS) protocol. Method In this cohort study, 224 patients scheduled for rectal resection for cancer or adenoma between January 2011 and January 2017 were evaluated. In the first time period (12 January 2011 to 23 April 2014), 47 (46%) of 102 patients had laparoscopic surgery. In the second time period (24 April 2014 to 30 January 2017), 72 (59%) of 122 patients had robotic surgery. Perioperative data and short‐term outcome were collected from the ERAS database and patient charts. Data obtained from laparoscopic and robotic surgery in the two time periods studied were compared. Primary outcome was hospital length of stay (LOS) and secondary outcomes were compliance to the ERAS protocol, difference in postoperative complications and conversion to open surgery. Results Compliance to the ERAS protocol was 81.1% in the robotic group and 83.4% in the laparoscopic group (P = 0.890). Robotic surgery was associated with shorter median LOS (3 days vs 7 days, P < 0.001), lower conversion rate (11.1% vs 34.0%, P = 0.002), lower rate of postoperative complications (25% vs 49%, P < 0.01) and longer duration of surgery (5.8 h vs 4.5 h, P < 0.001). The differences remained after multivariate analysis. Conclusion Robotic surgery was associated with shorter LOS, lower conversion rates and fewer postoperative complications compared with laparoscopic surgery. Robotic surgery may add benefits to the ERAS protocol.

show abstract

Section: Discussionmentioning

confidence: 99%

Robotic vs laparoscopic rectal tumour surgery: a cohort study

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patients who had higher compliance (≥ 70%) to the protocol had reduced risk of 5-year cancer-specific death, HR 0.58 (95% CI 0.39–0.88). Restricted perioperative fluid therapy, one of the elements of ERAS protocol, has also been shown to be related to improved 5-year survival (cancer-specific death, HR 0.45, 95% CI 0.25–0.81) [ 69 ].…”

Section: Eras Impact On Long-term Outcomesmentioning

confidence: 99%

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

et al. 2018

View full text Add to dashboard Cite

Enhanced Recovery After Surgery (ERAS) is an evidence-based paradigm shift in perioperative care, proven to lower both recovery time and postoperative complication rates. The role of ERAS in several surgical disciplines was reviewed. In colorectal surgery, ERAS protocol is currently well established as the best care. In gastric surgery, 2014 saw an establishment of ERAS protocol for gastrectomies with resulting meta-analysis showing ERAS effectiveness. ERAS has also been shown to be beneficial in liver surgery with many centers starting implementation. The advantages of ERAS in pancreatic surgery have been strongly established, but there is still a need for large-scale, multicenter randomized trials. Barriers to implementation were analyzed, with recent studies concluding that successful implementation requires a multidisciplinary team, a willingness to change and a clear understanding of the protocol. Additionally, the difficulty in accomplishing necessary compliance to all protocol items calls for new implementation strategies. ERAS success in different patient populations was analyzed, and it was found that in the elderly population, ERAS shortened the length of hospitalization and did not lead to a higher risk of postoperative complications or readmissions. ERAS utilization in the emergency setting is possible and effective; however, certain changes to the protocol may need to be adapted. Therefore, further research is needed. There remains insufficient evidence on whether ERAS actually improves patients’ course in the long term. However, since most centers started to implement ERAS protocol less than 5 years ago, more data are expected.

show abstract

“…However, in a randomized trial, Puckett et al [7] concluded that targeting a lower urine output allowed administration of a smaller amount of intraoperative fluid without significant effects on clinical outcomes. Furthermore, the association of perioperative fluid overload with worsening of postoperative morbidity is well-established [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis

et al. 2020

View full text Add to dashboard Cite

Background The enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection recommends balanced perioperative fluid therapy. According to recent guidelines, zero-balance fluid therapy is recommended in low-risk patients, and immediate correction of low urine output during surgery is discouraged. However, several reports have indicated an association of intraoperative oliguria with postoperative acute kidney injury (AKI). We investigated the impact of intraoperative oliguria in the colorectal ERAS setting on the incidence of postoperative AKI.

show abstract

The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery – A prospective cohort study within an ERAS protocol

Cited by 65 publications

References 26 publications

Robotic vs laparoscopic rectal tumour surgery: a cohort study

Robotic vs laparoscopic rectal tumour surgery: a cohort study

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis

Contact Info

Product

Resources

About