Weets Victoria, Meillat Hélène, Saadoun Jacques Emmanuel, Dazza Marie, de Chaisemartin Cécile, Lelong Bernard
Department of Digestive Surgical Oncology, Institute Paoli-Calmettes, Marseille, France.
Ann Coloproctol. 2024 Oct;40(5):440-450. doi: 10.3393/ac.2023.00850.0121. Epub 2024 Sep 20.
Enhanced Recovery After Surgery (ERAS) reduces postoperative complications (POCs) after colorectal surgery; however, its impact on the management of POCs remains unclear. This study compared the diagnosis and management of POCs before and after implementing our ERAS protocol after laparoscopic or robotic colectomy for cancer and examined the short- and mid-term oncologic impacts.
This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic or robotic colectomy for cancer between 2012 and 2021, focusing on the incidence of POCs within 90 days. We compared outcomes before (standard group) and after (ERAS group) the implementation of our ERAS protocol in January 2016.
Significantly fewer patients in the ERAS group developed POCs (standard vs. ERAS, 136 of 380 patients [35.8%] vs.136 of 660 patients [20.6%]; P<0.01). The ERAS group had a significantly shorter mean total length of stay after POCs (13.1 days vs. 11.4 days, P=0.04), and the rates of life-threatening complications (6.7% vs. 0.7%) and 1-year mortality (7.4% vs. 1.5%) were significantly lower in the ERAS group than in the standard group. Among patients with anastomotic complications, laparoscopic reoperation was significantly more common in the ERAS group than in the standard group (8.3% vs. 75.0%, P<0.01). Among patients with postoperative ileus, the diagnosis and recovery times were significantly shorter in the ERAS group than in the standard group, resulting in a shorter total length of stay (13.5 days vs. 10 days, P<0.01).
The implementation of an ERAS protocol did not eliminate all POCs, but it did accelerate their diagnosis and management and improved patient outcomes.
术后加速康复（ERAS）可降低结直肠手术后的术后并发症（POC）；然而，其对POC管理的影响仍不明确。本研究比较了在实施ERAS方案前后，腹腔镜或机器人辅助结肠癌切除术后POC的诊断和管理情况，并研究了短期和中期肿瘤学影响。
本单中心回顾性研究评估了2012年至2021年间所有连续接受腹腔镜或机器人辅助结肠癌切除术的患者，重点关注90天内POC的发生率。我们比较了2016年1月实施ERAS方案之前（标准组）和之后（ERAS组）的结果。
ERAS组发生POC的患者明显减少（标准组与ERAS组，380例患者中有136例[35.8%] vs. 660例患者中有136例[20.6%]；P<0.01）。ERAS组POC后的平均总住院时间明显缩短（13.1天 vs. 11.4天，P=0.04），ERAS组危及生命的并发症发生率（6.7% vs. 0.7%）和1年死亡率（7.4% vs. 1.5%）明显低于标准组。在吻合口并发症患者中，ERAS组腹腔镜再次手术的发生率明显高于标准组（8.3% vs. 75.0%，P<0.01）。在术后肠梗阻患者中，ERAS组的诊断和恢复时间明显短于标准组，总住院时间也更短（13.5天 vs. 10天，P<0.01）。
ERAS方案的实施并未消除所有POC，但确实加速了其诊断和管理，并改善了患者预后。
