Abstract
Aim
Enhanced recovery after surgery (ERAS) programmes and laparoscopic techniques both provide short-term benefits to patients undergoing colorectal cancer surgery. ERAS protocol compliance may improve long-term survival in those undergoing open colorectal resection but as laparoscopic data has not been reported. Therefore, we aimed to investigate the impact of the combination of laparoscopy and ERAS management on 5-year overall survival.
Methods
A dedicated prospectively populated colorectal cancer surgery database was reviewed. Patient inclusion criteria were biopsy-proven colorectal adenocarcinoma, undergoing elective surgery undertaken with curative intent. All patients were managed within an established ERAS programme and routinely followed up for 5 years. Overall survival was measured using the log-rank Kaplan-Meier method at 5 years.
Results
Eight hundred fifty-four patients met the inclusion criteria. Four hundred eighty-one (56%) cases were laparoscopic with 98 patients (20%) requiring conversion. There were no differences in patient or tumour demographics between the surgical groups. Median ERAS protocol compliance was 93% (range 53–100%). Five-year overall survival was superior in laparoscopic cases compared with that of converted and open surgery (78 vs 68 vs 70%, respectively, p < 0.007). An open approach (HR 1.55, 95%CI 1.16–2.06, p = 0.002) and delayed hospital discharge (> 7 days, HR 1.5, 95%CI 1.13–1.9, p = 0.003) were the only modifiable risk factors associated with poor survival.
Conclusions
The use of a laparoscopic approach with enhanced recovery after surgery management appears to have long-term survival benefits following colorectal cancer resection.
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Authors and Affiliations
Contributions
The project was conceived by NKF, ASA, RD, JO and RH. Study design was led by NKF, NJC and ES. Data acquisition was performed by NJC, MT, LF, ES, EN and managed by RH. Surgery and patient care was performed by all authors except ES and RH. Statistical analysis and data interpretation was performed by NJC, MT, ES, RH and NKF. The manuscript was drafted by NJC, MT, EN, ES and NKF and critically revised by all authors. All authors approved the final version.
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Ethical approval
For this retrospective study, formal approval was not required. However, initial database creation and review of already held, anonymised data was approved by our local research ethics and data governance committees.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Previous presentations: Presented to the 4th World Enhanced Recovery After Surgery (ERAS) Congress, Lisbon, Portugal, April 2016
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Curtis, N.J., Taylor, M., Fraser, L. et al. Can the combination of laparoscopy and enhanced recovery improve long-term survival after elective colorectal cancer surgery?. Int J Colorectal Dis 33, 231–234 (2018). https://doi.org/10.1007/s00384-017-2935-0
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DOI: https://doi.org/10.1007/s00384-017-2935-0