Feasibility and Outcomes of ERAS Protocol in Elective cT4 colorectal Cancer Patients. Results from a Single Center Retrospective Cohort Study.

BACKGROUND: Programs of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer. Patients presenting with more advanced disease such as T4 cancers, are frequently excluded from undergoing ERAS programs due to the difficulty in applying the whole or part of established protocols. The primary aim of this investigation was to evaluate the possibility of applying a validated ERAS protocol in patients undergoing colorectal resection for T4 colon and rectal cancer and to evaluate the short-term outcome. METHODS: Single center, retrospective cohort study. All patients with a clinical diagnosis of stage T4 colorectal cancer undergoing surgery between November 2016 to January 2020 were treated following the institutional fast track protocol without exclusion. Short-term postoperative outcomes were compared to those of a control group treated with conventional care and that underwent surgical resection for T4 colorectal cancer at the same institution from January 2010 to October 2016. Data from both groups were collected retrospectively from a prospectively maintained database. RESULTS: Eighty-two patients were diagnosed with T4 cancer, 49 patients were included in the ERAS cohort and 33 in the historical conventional care cohort. Both, the mean time of tolerance to solid food diet and postoperative length of stay, were significantly shorter in the ERAS group than in the control group (3.14±1,76 vs 4.8±1.52; p<0,0001 and 6,93±3,76 vs 9,50±4,83; p=0,0084 respectively). No differences in perioperative complications were observed. CONCLUSIONS: Results from this cohort study from a single center registry, shows that ERAS protocol is feasible also in T4 colorectal patients and enhance postoperative recovery in this group of patients.