Pisarska Magdalena, Gajewska Natalia, Małczak Piotr, Wysocki Michał, Major Piotr, Milian-Ciesielska Katarzyna, Budzyński Andrzej, Pędziwiatr Michał
2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland.
Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Kraków, Poland.
J Clin Med. 2018 Nov 4;7(11):412. doi: 10.3390/jcm7110412.
The aim of our study was to evaluate the implementation and degree of adherence to the Enhanced Recovery after Surgery (ERAS) protocol in a group of 400 patients operated laparoscopically for colorectal cancer, and to assess its impact on the short-term results. The prospective study included patients with histologically confirmed colorectal cancer undergoing elective laparoscopic resection from years 2012 to 2017. For the purpose of further analysis, patients were divided into four groups: 100 consecutive patients were in each group. There were no statistically significant differences between groups in demographic parameters. The mean compliance with the ERAS protocol in the entire study group was 84.8%. Median adherence differed between the groups 76.9% vs. 92.3% vs. 84.6% vs. 84.6%, respectively ( < 0.0001). There were statistically significant differences between groups in the tolerance of oral diet (54% vs. 83% vs. 83% vs. 64%) and mobilization (74% vs. 92% vs. 91% vs. 94%) on the first postoperative day. In subsequent groups, time to first flatus decreased (2.5 vs. 2.1 vs. 2.0 vs. 1.7 days, = 0.0001). There were no statistical differences in the postoperative morbidity rate between groups ( = 0.4649). The median length of hospital stay in groups was 5 vs. 4 vs. 4 vs. 4 days, respectively ( = 0.0025). Maintaining high compliance with the ERAS protocol is possible, despite the slight decrease that occurs within a few years after its implementation. This decrease in compliance does not affect short-term results, which are comparable to those shortly after overcoming the learning curve.
我们研究的目的是评估400例接受腹腔镜结直肠癌手术患者对加速康复外科（ERAS）方案的实施情况和依从程度，并评估其对短期结果的影响。这项前瞻性研究纳入了2012年至2017年期间接受择期腹腔镜切除、组织学确诊为结直肠癌的患者。为了进一步分析，将患者分为四组：每组100例连续患者。各组间人口统计学参数无统计学显著差异。整个研究组对ERAS方案的平均依从率为84.8%。各组间的中位依从性分别为76.9%、92.3%、84.6%和84.6%，差异有统计学意义（<0.0001）。术后第一天，各组在口服饮食耐受性（54% vs. 83% vs. 83% vs. 64%）和活动情况（74% vs. 92% vs. 91% vs. 94%）方面存在统计学显著差异。在后续组中，首次排气时间缩短（2.5天 vs. 2.1天 vs. 2.0天 vs. 1.7天，P = 0.0001）。各组间术后发病率无统计学差异（P = 0.4649）。各组的中位住院时间分别为5天、4天、4天和4天（P =
0.0025）。尽管在实施后的几年内依从性略有下降，但保持对ERAS方案的高依从性是可能的。这种依从性的下降并不影响短期结果，这些结果与克服学习曲线后不久的结果相当。
