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Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study

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Abstract

Background

Surgical stress can influence oncological outcome and survival. The enhanced recovery after surgery (ERAS) protocol is designed to reduce perioperative stress and has been shown to reduce postoperative morbidity. We studied if adherence to ERAS is associated with increased long-term survival.

Methods

Between the years 2002 and 2007, 911 consecutive patients, operated with major colorectal cancer surgery at Ersta Hospital, Stockholm, Sweden were analyzed. The histopathological reports of the resected specimen, date, and cause of death of the patients as well as postoperative CRP levels were obtained. The relation between the rate of adherence to the ERAS protocol at the time of surgery, and the short-term outcomes in relation to 5-year overall and colorectal cancer-specific survival was determined in this retrospective cohort study.

Results

In patients with ≥70 % adherence to ERAS interventions (N = 273,), the risk of 5-year cancer-specific death was lowered by 42 %, HR 0.58 (0.39–0.88, cox regression) compared to all other patients (<70 % adherence). Significant independent perioperative predictors of increased 5-year survival were avoiding overload of intravenous fluids, HR 0.53 (0.32–0.86); oral intake on the day of operation, HR 0.55 (0.34–0.78); and low CRP levels on postoperative day 1.

Conclusion

High adherence to the ERAS protocol may be associated with improved 5-year cancer-specific survival after colorectal cancer surgery.

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Acknowledgments

This work (design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, and review and approval of the manuscript) was supported by the funds from the Swedish Research Council (#09101), Stockholm County Council (SLL), Hans Mellström foundation and Erling-Persson Family Foundation. Professor Olle Ljungqvist is supported by Nyckelfonden, Sweden.

Funding

Funds from the Swedish Research Council (#09101), Stockholm County Council (SLL), Hans Mellström foundation and The Erling-Persson Family Foundation, Nyckelfonden, Örebro, Sweden.

Author information

Authors and Affiliations

  1. Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

    Ulf O. Gustafsson

  2. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

    Ulf O. Gustafsson, Henrik Oppelstrup, Anders Thorell & Jonas Nygren

  3. Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden

    Henrik Oppelstrup, Anders Thorell & Jonas Nygren

  4. Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Olle Ljungqvist

Authors
  1. Ulf O. Gustafsson
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  2. Henrik Oppelstrup
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  3. Anders Thorell
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  4. Jonas Nygren
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  5. Olle Ljungqvist
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Corresponding author

Correspondence to Ulf O. Gustafsson.

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Additional information

Senior authorship shared between Olle Ljungqvist and Jonas Nygren.

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Gustafsson, U.O., Oppelstrup, H., Thorell, A. et al. Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study. World J Surg 40, 1741–1747 (2016). https://doi.org/10.1007/s00268-016-3460-y

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