Colorectal Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble, France.
Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
Int J Colorectal Dis. 2022 May;37(5):1151-1159. doi: 10.1007/s00384-022-04155-1. Epub 2022 Apr 26.
Several recent studies have shown that the enhanced recovery after surgery (ERAS) protocol reduces morbidity and mortality and shortens the length of stay compared to conventional recovery strategy (pre-ERAS). The aim of this study was to evaluate the effect of the implementation of this protocol on 3-year overall survival and postoperative outcome in patients undergoing colorectal resection for cancer.
This was a retrospective, single-center, comparative, and non-randomized study. Between January, 2005, and December, 2017, 1001 patients were included (ERAS, n = 497; pre-ERAS, n = 504).
The 3-year overall survival rate was significantly better for ERAS than for pre-ERAS patients (76.1 vs 69.2%; p = 0.017). The length of hospital stay (median 10 days vs 15; p = ≤ 0.001) and the 90-day readmission rate (15 vs 20%; p = 0.037) were significantly lower in the ERAS group. Three-year recurrence-free survival (p = 0.398) and 90-day complications (p = 0.560) were similar in the two groups. Analysis of 3-year survival by a multivariate Cox model identified ERAS as a protective factor with a 30% reduction in the risk of death: (HR = 0.70 [0.55-0.90]).
The implementation of the ERAS protocol was associated with an improvement in 3-year survival, a reduction of the length of hospital stay and the rate of readmission. ERAS is associated with better 3-year survival, independent of other commonly considered parameters. An ASA score > 2, smoking, a history of cancer, and atrial fibrillation are deleterious risk factors linked to earlier mortality.
几项最近的研究表明，与传统康复策略（术前 ERAS）相比，手术后加速康复（ERAS）方案可降低发病率和死亡率，并缩短住院时间。本研究旨在评估该方案在接受结直肠癌手术的患者中对 3 年总生存率和术后结局的影响。
这是一项回顾性、单中心、对比和非随机研究。在 2005 年 1 月至 2017 年 12 月期间，共纳入 1001 例患者（ERAS 组，n=497；术前 ERAS 组，n=504）。
ERAS 组患者的 3 年总生存率明显高于术前 ERAS 组（76.1% vs 69.2%；p=0.017）。ERAS 组的住院时间（中位数 10 天 vs 15 天；p= ≤ 0.001）和 90 天再入院率（15% vs 20%；p=0.037）显著降低。两组 3 年无复发生存率（p=0.398）和 90 天并发症发生率（p=0.560）相似。多变量 Cox 模型分析 3 年生存率显示 ERAS 是一个保护因素，死亡风险降低 30%：（HR=0.70 [0.55-0.90]）。
ERAS 方案的实施与 3 年生存率的提高、住院时间和再入院率的降低有关。ERAS 与更好的 3 年生存率相关，与其他通常考虑的参数无关。ASA 评分>2、吸烟、癌症史和心房颤动是与早期死亡率相关的有害危险因素。
