Tidadini F, Trilling B, Sage P-Y, Durin D, Foote A, Quesada J-L, Faucheron J-L
Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France.
Univ. Grenoble-Alpes, CNRS, Grenoble INP, TIMC, 38000, Grenoble, France.
Tech Coloproctol. 2024 Dec 6;29(1):9. doi: 10.1007/s10151-024-03036-9.
The enhanced recovery after surgery (ERAS) protocol has been introduced over the past three decades for patients undergoing colorectal surgery. However, the effect of this program on long-term survival is poorly studied. We evaluated the effect of ERAS on 5-year overall survival (OS) and recurrence-free survival (RFS) after colorectal cancer surgery, and identified risk factors.
This retrospective study used data from the comparison of oncological outcomes at 3 years after ERAS or conventional care (pre-ERAS), conducted in our department between 2005 and 2017, and published in 2022. A total of 981 patients were included (ERAS, n = 486; pre-ERAS, n = 495).
The 5-year OS and RFS rates were similar in the ERAS and pre-ERAS groups, respectively (63.3% [58.9; 67.4] vs 57.7% [53.2; 61.9]; p = 0.055) and (69.5% [65.2; 73.4] vs 70.9% [66.6; 74.8]; p = 0.365). The 5-year OS result was confirmed by a propensity score analysis (HR 0.98 [0.71; 1.37], p = 0.911). Analysis of 5-year survival by a multivariate Cox model identified age (HR 1.28 [1.15; 1.43]), BMI < 18.5 (HR 1.62 [1.08; 2.45]), smoking (HR 1.68 [1.26; 2.24]), ASA score > 2 (HR 1.56 [1.22; 1.98]), and laparotomy interventions (HR 2.06 [1.61; 2.63]) as risk factors for death. Regarding RFS, multivariate analysis adjusted on the ERAS group identified age as a protective factor with a reduction of 10% in the risk of recurrence (HR 0.90 [0.81-0.99]). In contrast patients treated with neoadjuvant chemotherapy had a higher risk of recurrence (HR 1.41 [1.07-1.85]).
This study failed to demonstrate any advantage of the ERAS program in improving 5-year OS and RFS after colorectal cancer surgery. Age, undernutrition, smoking, ASA score > 2, and laparotomy interventions are independently associated with early mortality.
在过去三十年中，加速康复外科（ERAS）方案已被引入用于接受结直肠手术的患者。然而，该方案对长期生存的影响研究较少。我们评估了ERAS对结直肠癌手术后5年总生存率（OS）和无复发生存率（RFS）的影响，并确定了危险因素。
这项回顾性研究使用了2005年至2017年在我们科室进行的ERAS或传统护理（ERAS前）3年后肿瘤学结果比较的数据，并于2022年发表。共纳入981例患者（ERAS组，n = 486；ERAS前组，n = 495）。
ERAS组和ERAS前组的5年OS率和RFS率分别相似（63.3% [58.9；67.4] 对57.7% [53.2；61.9]；p = 0.055）和（69.5% [65.2；73.4] 对70.9% [66.6；74.8]；p = 0.365）。倾向评分分析证实了5年OS结果（HR 0.98 [0.71；1.37]，p = 0.911）。通过多变量Cox模型对5年生存率进行分析，确定年龄（HR 1.28 [1.15；1.43]）、BMI＜18.5（HR 1.62 [1.08；2.45]）、吸烟（HR 1.68 [1.26；2.24]）、ASA评分＞2（HR 1.56 [1.22；1.98]）和剖腹手术干预（HR 2.06 [1.61；2.63]）为死亡危险因素。关于RFS，在ERAS组进行调整的多变量分析确定年龄为保护因素，复发风险降低10%（HR 0.90 [0.81 - 0.99]）。相比之下，接受新辅助化疗的患者复发风险更高（HR 1.41 [1.07 - 1.85]）。
本研究未能证明ERAS方案在改善结直肠癌手术后5年OS和RFS方面有任何优势。年龄、营养不良、吸烟、ASA评分＞2和剖腹手术干预与早期死亡率独立相关。
