SpringerLink
Log in

Implementation of enhanced recovery after surgery and its increasing compliance improved 5-year overall survival in resectable stage III colorectal cancer

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Purpose

Enhanced recovery after surgery (ERAS) improves short-term outcomes after colorectal cancer (CRC) surgery, but its benefits on oncological results remain unclear. The objectives of this study are (1) to compare 5-year overall survival (OS) following non-metastatic CRC surgery between ERAS and conventional care (CC), and (2) to evaluate the association between ERAS compliance and OS.

Methods

Patients undergoing curative resection for stage I–III CRC in a university hospital were reviewed. Utilizing the 2010–2012 CRC registry, 5-year OS of surgical patients between ERAS and CC were compared. Utilizing the 2010–2016 ERAS registry, 5-year OS between patients with high ERAS compliance (≥ 70%) and their counterparts were compared.

Results

Between 2010 and 2012, 349 patients had curative surgery: 70 (20%) with ERAS and 279 (80%) with CC. The 5-year OS was 80.3% in ERAS and 65.6% in CC (HR 0.54, 95%CI 0.33–0.88, p = 0.014). After adjustment with other variables, ERAS was associated with better 5-year OS for stage III CRC only (72.6% vs. 57.2%, adjusted HR 0.54, 95%CI 0.30–0.98, p = 0.041). Regarding ERAS compliance, 320 patients were reviewed: 232 (73%) with high compliance. The 5-year OS was 83.9% in high compliance and 69.6% in low compliance (HR 0.49, 95% CI 0.29–0.83, p = 0.007). After adjustment with cancer staging, high compliance had better 5-year OS in stage III CRC only (80.5% vs. 60.7%, adjusted HR 0.44, 95%CI 0.23–0.84, p = 0.013).

Conclusion

ERAS was associated with improved 5-year OS following non-metastatic CRC surgery (especially stage III disease) than CC. High ERAS compliance had better OS than its counterpart.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Spain)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author on reasonable request. The data are not publicly available due to privacy or ethical restrictions.

References

  1. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298

    Article  Google Scholar 

  2. Greer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, Sultan S, Wilt TJ (2018) Enhanced recovery protocols for adults undergoing colorectal surgery: a systematic review and meta-analysis. Dis Colon Rectum 61:1108–1118

    Article  Google Scholar 

  3. Gustafsson UO, Oppelstrup H, Thorell A, Nygren J, Ljungqvist O (2016) Adherence to the ERAS protocol is associated with 5-year Survival after colorectal cancer surgery: a retrospective cohort study. World J Surg 40:1741–1747

    Article  Google Scholar 

  4. Pisarska M, Torbicz G, Gajewska N, Rubinkiewicz M, Wierdak M, Major P, Budzynski A, Ljungqvist O, Pedziwiatr M (2019) Compliance with the ERAS protocol and 3-year survival after laparoscopic surgery for non-metastatic colorectal cancer. World J Surg 43:2552–2560

    Article  Google Scholar 

  5. Lohsiriwat V (2014) Impact of an enhanced recovery program on colorectal cancer surgery. Asian Pac J Cancer Prev 15:3825–3828

    Article  Google Scholar 

  6. Viannay P, Hamy A, Jaouen R, Caroli-Bosc FX, Luel C, Vasseur S, Levaillant M, Hamel JF, Venara A (2019) Does enhanced recovery improve the survival rates of patients 3 years after undergoing surgery to remove a tumor in the colon? Int J Colorectal Dis 34:441–449

    Article  CAS  Google Scholar 

  7. Quiram BJ, Crippa J, Grass F, Lovely JK, Behm KT, Colibaseanu DT, Merchea A, Kelley SR, Harmsen WS, Larson DW (2019) Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer. Br J Surg 106:922–929

    Article  CAS  Google Scholar 

  8. Lohsiriwat V (2019) Learning curve of enhanced recovery after surgery program in open colorectal surgery. World J Gastrointest Surg 11:169–178

    Article  Google Scholar 

  9. Lohsiriwat V (2019) Enhanced recovery after surgery for emergency colorectal surgery: are there any differences between intra-abdominal infection and other indications? J Visc Surg 156:489–496

    Article  CAS  Google Scholar 

  10. Lohsiriwat V, Lohsiriwat D, Thavichaigarn P, Society of Colon and Rectal Surgeons Thailand (2009) Colorectal cancer screening and surveillance: a survey among Thai general surgeons. Asian Pac J Cancer Prev 10:467–470

    Google Scholar 

  11. Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey JN (2014) Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol 110:107–114

    Article  Google Scholar 

  12. Morrison B, Jones C, Kelliher L, Scott M, Dickinson M, Karanjia N, Quiney N (2017) ERAS for open liver resection surgery improves two-year survival but not five-year survival. Clin Nutr ESPEN 19:78

    Article  Google Scholar 

  13. Chan DS, Reid TD, Beamish AJ, Tanner NC, Havard T, Blackshaw G, Clark GW, Escofet X, Crosby T, Lewis WG (2012) Multidisciplinary upper gastrointestinal cancer team service centralization and enhanced recovery improve patient safety, outcome quality and survival significantly. Gastroenterology 142:S397

    Article  Google Scholar 

  14. Lohsiriwat V (2014) Enhanced recovery after surgery vs. conventional care in emergency colorectal surgery. World J Gastroenterol 20:13950–13955

    Article  Google Scholar 

  15. Lee L, Wong-Chong N, Kelly JJ, Nassif GJ, Albert MR, Monson JRT (2019) Minimally invasive surgery for stage III colon adenocarcinoma is associated with less delay to initiation of adjuvant systemic therapy and improved survival. Surg Endosc 33:460–470

    Article  Google Scholar 

  16. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, Participants in the VANSQIP (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:326–341

  17. Carli F (2015) Physiologic considerations of enhanced recovery after surgery (ERAS) programs: implications of the stress response. Can J Anaesth 62:110–119

    Article  Google Scholar 

  18. Yang J, Zhang T, Feng D, Dai X, Lv T, Wang X, Gong J, Zhu W, Li J (2019) A new diagnostic index for sarcopenia and its association with short-term postoperative complications in patients undergoing surgery for colorectal cancer. Colorectal Dis 21:538–547

    Article  CAS  Google Scholar 

  19. Penet MF, Bhujwalla ZM (2015) Cancer cachexia, recent advances, and future directions. Cancer J 21:117–122

    Article  Google Scholar 

  20. Faist E, Schinkel C, Zimmer S (1996) Update on the mechanisms of immune suppression of injury and immune modulation. World J Surg 20:454–459

    Article  CAS  Google Scholar 

  21. Wang WK, Tu CY, Shao CX, Chen W, Zhou QY, Zhu JD, Xu HT (2019) Impact of enhanced recovery after surgery on postoperative rehabilitation, inflammation, and immunity in gastric carcinoma patients: a randomized clinical trial. Braz J Med Biol Res 52:e8265

    Article  Google Scholar 

  22. Fairey AS, Courneya KS, Field CJ, Mackey JR (2002) Physical exercise and immune system function in cancer survivors: a comprehensive review and future directions. Cancer 94:539–551

    Article  Google Scholar 

  23. Li C, Pei Q, Zhu H, Tan F, Zhou Z, Zhou Y, Li Y, Pei H (2018) Survival nomograms for stage III colorectal cancer. Medicine (Baltimore) 97:e13239

    Article  Google Scholar 

  24. Gao P, Huang XZ, Song YX, Sun JX, Chen XW, Sun Y, Jiang YM, Wang ZN (2018) Impact of timing of adjuvant chemotherapy on survival in stage III colon cancer: a population-based study. BMC Cancer 18:234

    Article  Google Scholar 

  25. Tevis SE, Kohlnhofer BM, Stringfield S, Foley EF, Harms BA, Heise CP, Kennedy GD (2013) Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival. Dis Colon Rectum 56:1339–1348

    Article  Google Scholar 

  26. Lohsiriwat V, Lohsiriwat D, Chinswangwatanakul V, Akaraviputh T, Lert-Akyamanee N (2007) Comparison of short-term outcomes between laparoscopically-assisted vs. transverse-incision open right hemicolectomy for right-sided colon cancer: a retrospective study. World J Surg Oncol 5:49

    Article  Google Scholar 

  27. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg 43:659–695

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors gratefully thanked Mr. Udompunthurak from Clinical Epidemiology Unit, the Office for Research and Development, Faculty of Medicine Siriraj Hospital, for his assistance with statistical analysis.

Funding

None.

Author information

Authors and Affiliations

  1. Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lung Road, Bangkok, 10700, Thailand

    Varut Lohsiriwat

  2. Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Sarinda Lertbannaphong & Bundhawich Polakla

  3. Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Woramin Riansuwan

Authors
  1. Varut Lohsiriwat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarinda Lertbannaphong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bundhawich Polakla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Woramin Riansuwan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VL outlined the content and was a principal investigator. VL and SL reviewed literature. VL, SL, BP and WR collected data. VL and SL analyzed data and wrote the manuscript. BP and WR critically reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Varut Lohsiriwat.

Ethics declarations

Conflicts of interest

The authors declare that we have no conflicts of interest.

Ethics approval

This study was approved from the Institutional Ethics Committee (Approval number: Si482/2560).

Consent to participate

Written informed consent was obtained from each patient.

Consent for publication

Not applicable. (The identity of the subjects under this study was omitted and anonymized).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lohsiriwat, V., Lertbannaphong, S., Polakla, B. et al. Implementation of enhanced recovery after surgery and its increasing compliance improved 5-year overall survival in resectable stage III colorectal cancer. Updates Surg 73, 2169–2179 (2021). https://doi.org/10.1007/s13304-021-01004-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-021-01004-8

Keywords

Search

Navigation