Results of ERAS protocol in patients with colorectal cancer

Objective: explore the use of enhanced recovery after surgery (ERAS) in the treatment of patients with colorectal cancer, evaluate its efficacy and safety. Materials and methods. Prospective, single-site, randomized study for the implementation of enhanced recovery after surgery in patients with colorectal cancer has been conducted from October 2014 till the present time. All patients after laparoscopic surgeries undergo treatment according to ERAS protocol, patients after open surgeries are randomized (1:1) in groups of the standard treatment or treatment according to ERAS protocol. The study included patients with localized and locally disseminated colorectal cancer aged from 18 to 75 years, ECOG score ≤ 2. The primary evaluated parameters were the following: the number of postoperative complications (according to Clavien– Dindo classification), postoperative hospital days, incidence of complications and mortality in the 30-day period, timing of activation. Results. Up to date, the study includes 105 patients: laparoscopic group – 51 patients, open-surgery group of patients treated by ERAS protocol – 27 patients, open-surgery group of patients with the standard post-op treatment – 26 patients. Complications requiring emergency surgery for anastomotic leak (p = 0.159) developed in 3.7 % of patients with the standard post-op treatment and in 3.9 % of patients after laparoscopic surgery, while 1 patient required repeat hospitalization. The total number of complications was significantly lower in opensurgery group of patients treated by ERAS protocol compared with the standard post-op treatment (p = 0.021). However, there were no differences between laparoscopic and open-surgery group with the standard post-op treatment (p = 0.159). An average hospitalization stay in patients with the standard post-op treatment was equal to 10 days compared to 7 days in patients treated by ERAS protocol (p = 0.067) and 6 days after laparoscopic surgery (p = 0.001). No cases of 30 days mortality have been reported in all the groups. Conclusion. The use of ERAS protocol in our study allowed to reduce hospitalization time and provided an early activation of patients. There was a tendency towards the reduction in the number of postoperative complications. However, the resulted data is to be confirmed in a larger study.