Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer.

Autor: Quiram BJ; St Olaf College, Northfield, Minnesota, USA., Crippa J; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Grass F; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Lovely JK; Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA., Behm KT; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Colibaseanu DT; Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.; Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA., Merchea A; Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.; Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA., Kelley SR; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Harmsen WS; Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA., Larson DW; Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: The British journal of surgery [Br J Surg] 2019 Jun; Vol. 106 (7), pp. 922-929. Date of Electronic Publication: 2019 Mar 12.
DOI: 10.1002/bjs.11131
Abstrakt: Background: Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer.
Methods: This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care.
Results: A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272).
Conclusion: Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.
(© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: