Laparoscopy is not enough: full ERAS compliance is the key to improvement of short-term outcomes after colectomy for cancer

Abstract : Background: The enhanced recovery after surgery (ERAS) programs and laparoscopic techniques both reduce hospital stay and postoperative morbidity in patients undergoing colorectal cancer surgery. Laparoscopic techniques are an integral part of the ERAS program. However, evidence showing that the implementation of a multimodal rehabilitation program in addition to laparoscopy for colonic cancer would improve postoperative outcomes is still lacking. This study aimed to evaluate the impact of ERAS program on postoperative outcomes after elective laparoscopic colonic cancer resection. Methods: This is a single-center observational study from a prospectively maintained database. Two groups were formed from all patients undergoing laparoscopic colonic surgery for neoplasm during a defined period before (standard group) and after introduction of an ERAS program (ERAS group). The primary endpoint was postoperative 90-day morbidity. Secondary endpoints were the total length of hospital stay, readmission rate, and compliance with ERAS protocol. Results: A total of 320 patients were included in the analyses, with 160 patients in the standard group and 160 in the ERAS group. There were no differences in the baseline characteristics between the two groups. Overall morbidity was significantly lower in the ERAS group (21.25%) than that in the standard group (34.4%; OR = 0.52 [0.31-0.85], p < 0.01). This difference was not due to the reduction in major complications. Mean total hospital stay was significantly lower in the ERAS group (5.8 days) than that in the standard group (8.2 days, p < 0.01). There were no differences in readmission rates and anastomotic complications. Conclusions: The ERAS pathway reduced the overall morbidity rates and shortened the length of hospital stay, without increasing the readmission rates. A significant reduction in nonsurgical complications was evident, whereas no significant reduction was found for surgical complications.