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Does enhanced recovery improve the survival rates of patients 3 years after undergoing surgery to remove a tumor in the colon?

  • P. Viannay
  • A. Hamy
  • R. Jaouen
  • F. X. Caroli-Bosc
  • C. Luel
  • S. Vasseur
  • M. Levaillant
  • J. F. Hamel
  • Aurélien Venara
Original Article
  • 11 Downloads

Abstract

Purpose

The advantages of enhanced recovery programs (ERP) after colorectal surgery for morbidity and length of stay are well known. On a longer term, evidence is much more limited. The aim of this study is to determine the impact of ERP on survival after 3 years of follow-up, following colorectal cancer surgery.

Methods

All the patients undergoing resection for colorectal cancer between the years 2010 and 2014 were included. Patients were classified according to their compliance with the ERP (< 70 or ≥ 70%).

Results

Among the 206 patients included during the period, 129 were male (62.6%). The 3-year overall survival rate was 70.4% (145 patients) and relapse-free survival was 59.2% (122 patients). The survival after 3 years was influenced by the initial metastatic status (p < 0.0001), operative morbidity (p < 0.001), and the presence of peritumoral emboli (p = 0.006). However, the compliance with the ERP ≥ 70% did not influence overall survival (p = 0.63), nor relapse-free survival (p = 0.93). The same observations were found among the “at-risk” population (synchronous metastasis and postoperative complication).

Conclusion

The ERP does not seem to influence the 3-year relapse-free survival after colorectal resection for cancer.

Keywords

Enhanced recovery Colorectal cancer Global survival Disease-free survival 

Notes

Author’s contribution

A Venara and P Viannay made substantial contributions to the conception and design of this work, acquisition and interpretation of data and drafted the manuscript. They gave their final approval of the version to be published and their agreement to be held accountable for all aspects of the work.

A Hamy, R Jaouen, C Luel, FX Caroli-Bosc, and S Vasseur made substantial contributions to the acquisition and interpretation of data and critically revised the manuscript, as well as giving their final approval of the version to be published and their agreement to be held accountable for all aspects of the work.

M Levaillant and JF Hamel made substantial contributions to the interpretation and analysis of data and drafted the manuscript, as well as giving his final approval of the version to be published and his agreement to be held accountable for all aspects of the work.

Compliance with ethical standards

Conflict of interest

P Viannay, A Hamy, R Jaouen, FX Caroli-Bosc, C Luel, S Vasseur, M Levaillant, JF Hamel, and A Venara have no conflicts of interest or financial ties related to this work to disclose.

References

  1. 1.
    Alves A (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–283 discussion 284CrossRefPubMedGoogle Scholar
  2. 2.
    Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298CrossRefPubMedGoogle Scholar
  4. 4.
    Grant MC, Yang D, Wu CL, Makary MA, Wick EC (2017) Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg 265:68–79CrossRefPubMedGoogle Scholar
  5. 5.
    Slim K (2016) The benefits of enhanced recovery after surgery. J Visc Surg 153:S41–S44CrossRefPubMedGoogle Scholar
  6. 6.
    Roulin D, Donadini A, Gander S, Griesser AC, Blanc C, Hübner M, Schäfer M, Demartines N (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg 100:1108–1114CrossRefPubMedGoogle Scholar
  7. 7.
    Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J, Roche AM, Eisenstein EL, Edwards R, Anstrom KJ, Moon RE, Gan TJ, Enhanced Recovery Study Group (2014) Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 118:1052–1061CrossRefPubMedGoogle Scholar
  8. 8.
    Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, Umapathi BA, Kron IL, Sawyer RG, Hedrick TL, McMurry TL (2015) Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg 220:430–443CrossRefPubMedGoogle Scholar
  9. 9.
    Venara A, Duchalais E, Dariel A, Aubert P, Durand T, Meurette G, Rolli-Derkinderen M, Hamy A, Neunlist M (2018) Anti-inflammatory effects of enhanced recovery programs on early-stage colorectal cancer surgery. World J Surg 42:953–964CrossRefPubMedGoogle Scholar
  10. 10.
    Cabellos Olivares M, Labalde Martínez M, Torralba M, Rodríguez Fraile JR, Atance Martínez JC (2018) C-reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: a prospective cohort study. J Surg Oncol 117:717–724CrossRefPubMedGoogle Scholar
  11. 11.
    Mari G, Costanzi A, Crippa J et al (2016) Surgical stress reduction in elderly patients undergoing elective colorectal laparoscopic surgery within an ERAS protocol. Chir Buchar 111:476–480Google Scholar
  12. 12.
    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 40:1741–1747CrossRefPubMedGoogle Scholar
  13. 13.
    Curtis NJ, Taylor M, Fraser L, Salib E, Noble E, Hipkiss R, Allison AS, Dalton R, Ockrim JB, Francis NK (2018) Can the combination of laparoscopy and enhanced recovery improve long-term survival after elective colorectal cancer surgery? Int J Color Dis 33:231–234CrossRefGoogle Scholar
  14. 14.
    Lecomte T, André T, Bibeau F, Blanc B, Cohen R, Lagasse JP, Laurent-Puig P, Martin-Babau J, Panis Y, Portales F, Taieb J, Vaillant E. «Cancer du côlon non métastatique». Thésaurus National de Cancérologie Digestive, 11–2017, [En ligne] http://www.tncd.org
  15. 15.
    Mariette C, Alves A, Benoist S, Bretagnol F, Mabrut JY, Slim K (2005) Perioperative care in digestive surgery. Guidelines for the French society of digestive surgery (SFCD). Ann Chir 130:108–124CrossRefPubMedGoogle Scholar
  16. 16.
    Grass F, Slieker J, Jurt J, Kummer A, Solà J, Hahnloser D, Demartines N, Hübner M (2017) Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study. Int J Color Dis 32:675–681CrossRefGoogle Scholar
  17. 17.
    Manfredi S, Bouvier AM, Lepage C, Hatem C, Dancourt V, Faivre J (2006) Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br J Surg 93:1115–1122CrossRefPubMedGoogle Scholar
  18. 18.
    Manfredi S, Benhamiche AM, Meny B, Cheynel N, Rat P, Faivre J (2001) Population-based study of factors influencing occurrence and prognosis of local recurrence after surgery for rectal cancer. Br J Surg 88:1221–1227CrossRefPubMedGoogle Scholar
  19. 19.
    Haga Y, Ikejiri K, Wada Y, Ikenaga M, Koike S, Nakamura S, Koseki M (2015) The EPOS-CC score: an integration of independent, tumor- and patient-associated risk factors to predict 5-years overall survival following colorectal Cancer surgery. World J Surg 39:1567–1577CrossRefPubMedGoogle Scholar
  20. 20.
    Tougeron D, Sickersen G, Mouillet G et al (2015) Predictors of disease-free survival in colorectal cancer with microsatellite instability: an AGEO multicentre study. Eur J Cancer 51:925–934CrossRefPubMedGoogle Scholar
  21. 21.
    Asklid D, Segelman J, Gedda C, Hjern F, Pekkari K, Gustafsson UO (2017) The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery—a prospective cohort study within an ERAS protocol. Eur J Surg Oncol 43:1433–1439CrossRefPubMedGoogle Scholar
  22. 22.
    Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen L-L (2016) Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol 16:55CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101:172–188CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • P. Viannay
    • 1
    • 2
  • A. Hamy
    • 1
    • 2
    • 3
  • R. Jaouen
    • 1
    • 2
  • F. X. Caroli-Bosc
    • 2
    • 3
    • 4
  • C. Luel
    • 2
  • S. Vasseur
    • 2
  • M. Levaillant
    • 5
  • J. F. Hamel
    • 2
    • 5
  • Aurélien Venara
    • 1
    • 2
    • 3
    • 6
  1. 1.Department of Visceral and Endocrinal SurgeryCHU AngersAngers Cedex 9France
  2. 2.Département de MédecineUFR Santé d’AngersAngersFrance
  3. 3.EA HIFIHAngersFrance
  4. 4.Department of Digestive and Liver DiseaseCHU AngersAngers Cedex 9France
  5. 5.Department of BiostatisticsCHU AngersAngers Cedex 9France
  6. 6.UMR INSERM 1235, TENSUniversité de NantesNantesFrance

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