Real-world implementation of a geriatric-specific ERAS protocol in patients undergoing colonic cancer surgery

Autor: C. Braticevic, Bernard Lelong, Marion Faucher, C. de Chaisemartin, M. Cécile, Clément Brun, Christophe Zemmour, Hélène Meillat
Přispěvatelé: Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Malbec, Odile
Rok vydání: 2020
Předmět:
Zdroj: EJSO-European Journal of Surgical Oncology
EJSO-European Journal of Surgical Oncology, WB Saunders, 2020, 47 (5), pp.1012-1018. ⟨10.1016/j.ejso.2020.11.128⟩
ISSN: 1532-2157
0748-7983
DOI: 10.1016/j.ejso.2020.11.128⟩
Popis: International audience; Background: The aim of this single-center observational study was to evaluate the impact of implementing Enhanced Recovery After Surgery (ERAS) protocols, combined with systematic geriatric assessment and support, on surgical and oncological outcomes in patients aged 70 or older undergoing colonic cancer surgery. Methods: Two groups were formed from an actively maintained database from all patients undergoing laparoscopic colonic surgery for neoplasms during a defined period before (standard group) or after (ERAS group) the introduction of an ERAS program associated with systematic geriatric assessment. The primary outcome was postoperative 90-day morbidity. Secondary outcomes were total length of hospital stay, initiated and completed adjuvant chemotherapy (AC) rate, and 1-year mortality rate. Results: A total of 266 patients (135 standard and 131 ERAS) were included in the study. Overall 90-day morbidity and mean hospital stay were significantly lower in the ERAS group than in the standard group (22.1% vs. 35.6%, p ¼ 0.02; and 6.2 vs. 9.3 days, p < 0.01, respectively). There were no differences in readmission rates and anastomotic complications. AC was recommended in 114 patients. The rate of initiated treatment was comparable between the groups (66.6% vs. 77.7%, p ¼ 0.69). The rate of completed AC was significantly higher in the ERAS group (50% vs. 20%, p < 0.01) with a lower toxicity rate (57.1% vs. 87.5%, p ¼ 0.002). The 1-year mortality rate was higher in the standard group (7.4% vs. 0.8%, p < 0.01). Conclusions: The combination of ERAS protocols and geriatric assessment and support reduces the overall morbidity rate and improves 12-month oncologic outcomes.
Databáze: OpenAIRE
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