Improving postoperative outcome in rectal cancer surgery: Enhanced Recovery After Surgery in an era of increasing laparoscopic resection.

Autor: Bakker N; Northwest Clinics, Department of Surgery, NWZ Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands.; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Doodeman HJ; Northwest Clinics, Department of Surgery, NWZ Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands., Dunker MS; Northwest Clinics, Department of Surgery, NWZ Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands., Schreurs WH; Northwest Clinics, Department of Surgery, NWZ Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands., Houdijk APJ; Northwest Clinics, Department of Surgery, NWZ Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands. a.p.j.houdijk@nwz.nl.; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. a.p.j.houdijk@nwz.nl.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2021 Dec; Vol. 406 (8), pp. 2769-2779. Date of Electronic Publication: 2021 Jul 26.
DOI: 10.1007/s00423-021-02266-x
Abstrakt: Purpose: The Enhanced Recovery After Surgery (ERAS) protocol reduces complications and length of stay (LOS) in colon cancer, but implementation in rectal cancer is different because of neo-adjuvant therapy and surgical differences. Laparoscopic resection may further improve outcome. The aim of this study was to evaluate the effects of introducing ERAS on postoperative outcome after rectal cancer resection in an era of increasing laparoscopic resections.
Materials and Methods: Patients who underwent elective rectal cancer surgery from 2009 till 2015 were included in this observational cohort study. In 2010, ERAS was introduced and adherence to the protocol was registered. Open and laparoscopic resections were compared. With regression analysis, predictive factors for postoperative outcome and LOS were identified.
Results: A total of 499 patients were included. The LOS decreased from 12.3 days in 2009 to 5.7 days in 2015 (p = 0.000). Surgical site infections were reduced from 24% in 2009 to 5% in 2015 (p = 0.013) and postoperative ileus from 39% in 2009 to 6% in 2015 (p = 0.000). Only postoperative ERAS items and laparoscopic surgery were associated with an improved postoperative outcome and shorter LOS.
Conclusions: ERAS proved to be feasible, safe, and contributed to improving short-term outcome in rectal cancer resections. The benefits of laparoscopic surgery may in part be explained by reaching better ERAS adherence rates. However, the laparoscopic approach was also associated with anastomotic leakage. Despite the potential of bias, this study provides an insight in effects of ERAS and laparoscopic surgery in a non-randomized real-time setting.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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