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Abstract

Aims

ERAS improves post operative recovery following colorectal resections. ERAS is applicable to both laparoscopic and open surgery. Aim of study is to assess effectiveness of ERAS in malignant colorectal cancer (CRC) resections.

Methods

Single-centre cohort study evaluated post operative outcomes in elective malignant CRC resections from January 2008 to February 2023. CRC resections performed without ERAS were used as controls.

Results
ERAS (n = 1012)Non ERAS (n = 256)Mann Whitney U (p value)
Age (yrs)70.471.6NS
Sex (M:F)575 : 437148 : 108NS
ASA22NS
BMI262NS
Laparoscopic (n)74479< 0.0001
Operation time (mins)194.141< 0.0001
LN harvest (median)1715NS
Ileostomy / colostomy25860NS
Delayed ERAS (n)69
LOS median (days)79< 0.0001
90 D Mortality (n)2912NS
Anastomotic leaks (n)3716NS
Ileus (n)14445NS
HAP (n)9227NS
Anaemia (transfusions) n2914NS
Survival rates yrs (%)
 1st94.590.9Logrank
 5th81.874.5p = < 0.05
 10th76.762.6(uncensored)
 15th74.258.3
ERAS (n = 1012)Non ERAS (n = 256)Mann Whitney U (p value)
Age (yrs)70.471.6NS
Sex (M:F)575 : 437148 : 108NS
ASA22NS
BMI262NS
Laparoscopic (n)74479< 0.0001
Operation time (mins)194.141< 0.0001
LN harvest (median)1715NS
Ileostomy / colostomy25860NS
Delayed ERAS (n)69
LOS median (days)79< 0.0001
90 D Mortality (n)2912NS
Anastomotic leaks (n)3716NS
Ileus (n)14445NS
HAP (n)9227NS
Anaemia (transfusions) n2914NS
Survival rates yrs (%)
 1st94.590.9Logrank
 5th81.874.5p = < 0.05
 10th76.762.6(uncensored)
 15th74.258.3
ERAS (n = 1012)Non ERAS (n = 256)Mann Whitney U (p value)
Age (yrs)70.471.6NS
Sex (M:F)575 : 437148 : 108NS
ASA22NS
BMI262NS
Laparoscopic (n)74479< 0.0001
Operation time (mins)194.141< 0.0001
LN harvest (median)1715NS
Ileostomy / colostomy25860NS
Delayed ERAS (n)69
LOS median (days)79< 0.0001
90 D Mortality (n)2912NS
Anastomotic leaks (n)3716NS
Ileus (n)14445NS
HAP (n)9227NS
Anaemia (transfusions) n2914NS
Survival rates yrs (%)
 1st94.590.9Logrank
 5th81.874.5p = < 0.05
 10th76.762.6(uncensored)
 15th74.258.3
ERAS (n = 1012)Non ERAS (n = 256)Mann Whitney U (p value)
Age (yrs)70.471.6NS
Sex (M:F)575 : 437148 : 108NS
ASA22NS
BMI262NS
Laparoscopic (n)74479< 0.0001
Operation time (mins)194.141< 0.0001
LN harvest (median)1715NS
Ileostomy / colostomy25860NS
Delayed ERAS (n)69
LOS median (days)79< 0.0001
90 D Mortality (n)2912NS
Anastomotic leaks (n)3716NS
Ileus (n)14445NS
HAP (n)9227NS
Anaemia (transfusions) n2914NS
Survival rates yrs (%)
 1st94.590.9Logrank
 5th81.874.5p = < 0.05
 10th76.762.6(uncensored)
 15th74.258.3
Conclusion

ERAS was employed in more laparoscopic CRC resections. ERAS discontinuation in major surgical complications. Despite prolonged operation in ERAS group (p < 0.0001), hospital stay was significantly shorter (p < 0.0001). Survival rates were better in the ERAS group (Logrank p < 0.05), explained by ERAS wholly implemented & non ERAS were historical cases. Delayed ERAS occurred in 6.9 % of cases & can account towards delays in hospital discharge. This study demonstrated a targeted rehabilitation programme and early diagnosis of surgical complications can facilitate post-operative recovery.

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