Ann Coloproctol.  2017 Jun;33(3):86-92. 10.3393/ac.2017.33.3.86.

Standardizing the Protocols for Enhanced Recovery From Colorectal Cancer Surgery: Are We a Step Closer to Ideal Recovery?

• Shetiwy M
• Fady T
• Shahatto F
• Setit A

• KMID: 2385405
• DOI: http://doi.org/10.3393/ac.2017.33.3.86

Abstract

PURPOSE
Enhanced recovery protocols are being implemented into the standard of care in surgical practice. This study aimed to insert a steadfast set of elements into the perioperative care pathway to establish an improved recovery program for colorectal cancer patients.
METHODS
Seventy patients planned for elective laparoscopic colorectal resection were randomized into 2 groups: conventional recovery group (n = 35) and enhanced recovery group (n = 35). The primary outcome was the length of hospital stay. Secondary outcomes included the times of removal of nasogastric tubes (NGTs), successful enteral feeding, and removal of drains, postoperative complications, intra-hospital mortality, and rate of readmission.
RESULTS
The mean postoperative hospital stay was 4.49 ± 0.85 days vs. 13.31 ± 6.9 days (P < 0.001), the mean time of removal of NGTs was 0.77 ± 1.031 days vs. 3.26 ± 2.737 days (P < 0.001), the mean time of successful enteral feeding was 1.89 ± 1.13 days vs. 5.46 ± 1.67 days (P < 0.001), and the mean time for removal of intra-abdominal drains was 2.94 ± 1.056 days vs. 9.06 ± 3.757 days (P < 0.001) for the enhanced and the conventional groups, respectively. Complications were significantly lower among patients in the enhanced group (25.7% vs. 65.7%) (P = 0.001). The rates of readmission were similar in the 2 groups.
CONCLUSION
Applying definite evidence-based elements to the colorectal rehabilitation program significantly boosts the recovery pathway with favorable outcomes, including faster recovery of gastrointestinal tract functions, lower morbidities, and eventually earlier discharge from the hospital.

Keyword

Perioperative care; Colorectal surgery; Laparoscopy; Fast track surgery; Prospective studies

MeSH Terms

Colorectal Neoplasms*
Colorectal Surgery
Enteral Nutrition
Gastrointestinal Tract
Humans
Laparoscopy
Length of Stay
Mortality
Perioperative Care
Postoperative Complications
Prospective Studies
Rehabilitation
Standard of Care