Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France.
Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France.
Surg Endosc. 2020 May;34(5):2067-2075. doi: 10.1007/s00464-019-06987-5. Epub 2019 Aug 5.
The enhanced recovery after surgery (ERAS) programs and laparoscopic techniques both reduce hospital stay and postoperative morbidity in patients undergoing colorectal cancer surgery. Laparoscopic techniques are an integral part of the ERAS program. However, evidence showing that the implementation of a multimodal rehabilitation program in addition to laparoscopy for colonic cancer would improve postoperative outcomes is still lacking. This study aimed to evaluate the impact of ERAS program on postoperative outcomes after elective laparoscopic colonic cancer resection.
This is a single-center observational study from a prospectively maintained database. Two groups were formed from all patients undergoing laparoscopic colonic surgery for neoplasm during a defined period before (standard group) and after introduction of an ERAS program (ERAS group). The primary endpoint was postoperative 90-day morbidity. Secondary endpoints were the total length of hospital stay, readmission rate, and compliance with ERAS protocol.
A total of 320 patients were included in the analyses, with 160 patients in the standard group and 160 in the ERAS group. There were no differences in the baseline characteristics between the two groups. Overall morbidity was significantly lower in the ERAS group (21.25%) than that in the standard group (34.4%; OR = 0.52 [0.31-0.85], p < 0.01). This difference was not due to the reduction in major complications. Mean total hospital stay was significantly lower in the ERAS group (5.8 days) than that in the standard group (8.2 days, p < 0.01). There were no differences in readmission rates and anastomotic complications.
The ERAS pathway reduced the overall morbidity rates and shortened the length of hospital stay, without increasing the readmission rates. A significant reduction in nonsurgical complications was evident, whereas no significant reduction was found for surgical complications.
手术快速康复（ERAS）方案和腹腔镜技术均可减少结直肠癌手术患者的住院时间和术后发病率。腹腔镜技术是 ERAS 方案的重要组成部分。然而，尚无证据表明，除了腹腔镜手术之外，实施多模式康复方案会改善结肠癌患者的术后结局。本研究旨在评估 ERAS 方案对择期腹腔镜结直肠癌切除术后术后结局的影响。
这是一项来自前瞻性维护数据库的单中心观察性研究。在规定时期内，将所有接受腹腔镜结直肠手术治疗肿瘤的患者分为两组：标准组（在引入 ERAS 方案之前）和 ERAS 组（在引入 ERAS 方案之后）。主要终点是术后 90 天发病率。次要终点是总住院时间、再入院率和 ERAS 方案的依从性。
共纳入 320 例患者进行分析，其中标准组 160 例，ERAS 组 160 例。两组患者的基线特征无差异。ERAS 组的总发病率（21.25%）明显低于标准组（34.4%；OR=0.52[0.31-0.85]，p<0.01）。这种差异不是由于主要并发症的减少所致。ERAS 组的平均总住院时间（5.8 天）明显短于标准组（8.2 天，p<0.01）。再入院率和吻合口并发症无差异。
ERAS 途径降低了总体发病率并缩短了住院时间，而不会增加再入院率。非手术并发症显著减少，而手术并发症则无明显减少。
