DOI QR코드

DOI QR Code

Impact of Enhanced Recovery Program on Colorectal Cancer Surgery

  • Lohsiriwat, Varut
  • Published : 2014.04.30

Abstract

Surgical outcomes of colorectal cancer treatment depend not only on good surgery and tumor biology but also on an optimal perioperative care. The enhanced recovery program (ERP) - a multidisciplinary and multimodal approach, or so called 'fast-track surgery' - has been designed to minimize perioperative and intraoperative stress responses, and to support the recovery of organ function aiming to help patients getting better sooner after surgery. Compared with conventional postoperative care, the enhanced recovery program results in quicker patient recovery, shorter length of hospital stay, faster recovery of gastrointestinal function, and a lower incidence of postoperative complications. Although not firmly established as yet, the enhanced recovery program after surgery could be of oncological benefit in colorectal cancer patients because it can enhance recovery, maintain integrity of the postoperative immune system, increase feasibility of postoperative chemotherapy, and shorten the time interval from surgery to chemotherapy. This commentary summarizes short-term outcomes and potential long-term benefits of enhanced recovery programs in the treatment of colorectal cancer.

Keywords

Enhanced recovery program;enhanced recovery after surgery;colon cancer;rectal cancer;survival

References

  1. Vlug MS, Wind J, Hollmann MW, et al (2011). Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg, 254, 868-75. https://doi.org/10.1097/SLA.0b013e31821fd1ce
  2. Nicholson A, Lowe MC, Parker J, et al (2014). Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg, 101, 172-88. https://doi.org/10.1002/bjs.9394
  3. Nygren J, Thacker J, Carli F, et al (2013). Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. World J Surg, 37, 285-305. https://doi.org/10.1007/s00268-012-1787-6
  4. Schmoll HJ, Van Cutsem E, Stein A, et al (2012). ESMO consensus guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol, 23, 2479-516. https://doi.org/10.1093/annonc/mds236
  5. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011). Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev, CD007635.
  6. Wang G, Jiang Z, Zhao K, et al (2012). Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program. J Gastrointest Surg, 16, 1379-88. https://doi.org/10.1007/s11605-012-1880-z
  7. Zhang XD, Zhao QY, Fang Y, et al (2013). Perioperative comprehensive supportive care interventions for Chinese patients with esophageal carcinoma: a prospective study. Asian Pac J Cancer Prev, 14, 7359-66. https://doi.org/10.7314/APJCP.2013.14.12.7359
  8. Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013). Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum, 56, 667-78. https://doi.org/10.1097/DCR.0b013e3182812842
  9. Lassen K, Soop M, Nygren J, et al (2009). Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 144, 961-9. https://doi.org/10.1001/archsurg.2009.170
  10. Karanika S, Karantanos T, Theodoropoulos G (2013). Immune response after laparoscopic colectomy for cancer: a review. Gastroenterol Rep, 1, 85-94. https://doi.org/10.1093/gastro/got014
  11. Khan S, Wilson T, Ahmed J, Owais A, MacFie J (2010). Quality of life and patient satisfaction with enhanced recovery protocols. Colorectal Dis, 12, 1175-82. https://doi.org/10.1111/j.1463-1318.2009.01997.x
  12. Lassen K, Coolsen MM, Slim K, et al (2013). Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. World J Surg, 37, 240-58. https://doi.org/10.1007/s00268-012-1771-1
  13. Lemanu DP, Singh PP, Stowers MD, Hill AG (2014). A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Colorectal Dis, 16, 338-46. https://doi.org/10.1111/codi.12505
  14. Li P, Fang F, Cai JX, et al (2013). Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: a meta-analysis. World J Gastroenterol, 19, 9119-26. https://doi.org/10.3748/wjg.v19.i47.9119
  15. Lohsiriwat V, Lohsiriwat D, Boonnuch W, et al (2009). Comparison between midline and right transverse incision in right hemicolectomy for right-sided colon cancer: a retrospective study. J Med Assoc Thai, 92, 1003-8.
  16. Lohsiriwat V, Lohsiriwat D, Boonnuch W, et al (2008). Outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain, and risk factors for anastomotic leakage. Dig Surg, 25, 191-7. https://doi.org/10.1159/000140688
  17. Merkow RP, Bentrem DJ, Mulcahy MF, et al (2013). Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Ann Surg, 258, 847-53. https://doi.org/10.1097/SLA.0000000000000312
  18. Haverkamp MP, de Roos MA, Ong KH (2012). The ERAS protocol reduces the length of stay after laparoscopic colectomies. Surg Endosc, 26, 361-7. https://doi.org/10.1007/s00464-011-1877-9
  19. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al (2005). Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 24, 466-77. https://doi.org/10.1016/j.clnu.2005.02.002
  20. Gustafsson UO, Hausel J, Thorell A, et al (2011). Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg, 146, 571-7. https://doi.org/10.1001/archsurg.2010.309
  21. Gustafsson UO, Scott MJ, Schwenk W, et al (2013). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(R)) society recommendations. World J Surg, 37, 259-84. https://doi.org/10.1007/s00268-012-1772-0
  22. Hershman D, Hall MJ, Wang X, et al (2006). Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer. Cancer, 107, 2581-8. https://doi.org/10.1002/cncr.22316
  23. Huibers CJ, de Roos MA, Ong KH (2012). The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis, 27, 751-7. https://doi.org/10.1007/s00384-011-1385-3
  24. Hung HC, Chien TW, Tsay SL, Hang HM, Liang SY (2013). Patient and clinical variables account for changes in healthrelated quality of life and symptom burden as treatment outcomes in colorectal cancer: a longitudinal study. Asian Pac J Cancer Prev, 14, 1905-9. https://doi.org/10.7314/APJCP.2013.14.3.1905
  25. Jottard KJ, van Berlo C, Jeuken L, Dejong C (2008). Changes in outcome during implementation of a fast-track colonic surgery project in a university-affiliated general teaching hospital: advantages reached with ERAS (Enhanced Recovery After Surgery project) over a 1-year period. Dig Surg, 25, 335-8. https://doi.org/10.1159/000158910
  26. Kahokehr A, Robertson P, Sammour T, Soop M, Hill AG (2011). Perioperative care: a survey of New Zealand and Australian colorectal surgeons. Colorectal Dis, 13, 1308-13. https://doi.org/10.1111/j.1463-1318.2010.02453.x
  27. Augestad KM, Lindsetmo RO, Reynolds H, et al (2011). International trends in surgical treatment of rectal cancer. Am J Surg, 201, 353-7. https://doi.org/10.1016/j.amjsurg.2010.08.030
  28. Berglund A, Cedermark B, Glimelius B (2008). Is it deleterious to delay the start of adjuvant chemotherapy in colon cancer stage III? Ann Oncol, 19, 400-2. https://doi.org/10.1093/annonc/mdm582
  29. Biagi JJ, Raphael MJ, Mackillop WJ, et al (2011). Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and metaanalysis. JAMA, 305, 2335-42. https://doi.org/10.1001/jama.2011.749
  30. Cakir H, van Stijn MF, Lopes Cardozo AM, et al (2013). Adherence to enhanced recovery after surgery and length of stay after colonic resection. Colorectal Dis, 15, 1019-25. https://doi.org/10.1111/codi.12200

Cited by

  1. Impact of a Clinical Pathway on Hospital Costs, Length of Stay and Early Outcomes after Hepatectomy for Hepatocellular Carcinoma vol.15, pp.13, 2014, https://doi.org/10.7314/APJCP.2014.15.13.5389
  2. The influence of preoperative nutritional status on the outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery vol.18, pp.11, 2014, https://doi.org/10.1007/s10151-014-1210-4
  3. Atraumatic O-ring wound retractor reduces postoperative pain vol.18, pp.12, 2014, https://doi.org/10.1007/s10151-014-1225-x
  4. Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS vol.31, pp.9, 2016, https://doi.org/10.1007/s00384-016-2621-7
  5. Acupuncture for recovery after surgery in patients undergoing colorectal cancer resection: a systematic review and meta-analysis vol.34, pp.4, 2016, https://doi.org/10.1136/acupmed-2015-010941
  6. 90-Day complication rate in patients undergoing radical cystectomy with enhanced recovery protocol: a prospective cohort study vol.35, pp.6, 2017, https://doi.org/10.1007/s00345-016-1950-z
  7. Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis vol.33, pp.3, 2018, https://doi.org/10.1007/s00384-017-2958-6