Feasibility of a tailored ERAS programme in octogenarian patients undergoing minimally invasive surgery for colorectal cancer
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The enhanced recovery after surgery (ERAS) is nowadays a widely accepted multimodal programme of care in colorectal surgery, but still there is some reluctance in its application to very elderly patients.
The aim of this study is to investigate short-term outcomes of laparoscopic resection for colorectal cancer in octogenarian patients within the ERAS programme.
Data on 162 consecutive patients aged ≥ 80 years receiving elective minimally invasive colorectal resections within ERAS programme were collected in a multicentre, retrospective database in the period 2008–2017 in Italy. Univariate and multivariate analyses were performed to assess possible risk factors for poor clinical outcomes.
The postoperative minor morbidity rate (Clavien–Dindo 1 and 2) was 25.9%. The incidence of postoperative major morbidity rate (severe medical and surgical complications defined as Clavien–Dindo 3 and 4) accounted 6.1% and only 1.8% had an anastomotic leakage. Reoperation rate was 5.5%, perioperative 30-day mortality was 1.8%, and 30-day readmission rate was 6.8%. On average, patients were released after 6 days. A univariate analysis showed that possible risk factors for severe medical complications were: low preoperative albumin level, high Charlson Age Comorbidity Index Score and number of days in the intensive care unit (ICU); risk factors for severe surgical complications were: low preoperative albumin level; risk factors for late hospital discharge were: multivisceral resections, number of days in ICU and body mass index (BMI) > 25 kg/m2. The multivariate analysis confirmed a low level of preoperative albumin and a longer ICU stay as independent risk factors for both postoperative severe surgical complications and late hospital discharge.
The minimal invasive nature of the laparoscopic approach together with a multimodal analgesia therapy, the early resumption to oral diet and mobilisation could minimize the surgical stress and play an essential role in order to reduce medical morbidity in high-risk patients.
Colorectal surgery within ERAS programme in octogenarians is a safe and flexible treatment in high-volume centres.
KeywordsLaparoscopic colorectal resection Octogenarian patients ERAS program in colorectal surgery Colorectal cancer
The research presented here was the product of a team-work. Doctor CD and doctor DN contributed to the design and supervised all the research’s process. Doctor GM was in charge of the statistical analysis and also provided a general support to the manuscript. Thanks go to doctor FM, AA and BV for their assistance with data collection. We gratefully acknowledge the support and professionalism of doctor BG and VM who performed all the surgical procedures.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Compliance with ethical standards
Conflict of interest
The present paper is not based on any previous communication to a society or meeting. The authors declare they have no conflict of interest.
This study was approved by the institutional Ethics Committee and conducted according to the declaration of Helsinki.
Informed consent was obtained from all patients. All authors gave their consentment for paper publication.
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