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Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study
Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
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2016 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, no 7, 1741-1747 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
New York, USA: Springer, 2016. Vol. 40, no 7, 1741-1747 p.
National Category
Cancer and Oncology Surgery
Research subject
Oncology; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-51139DOI: 10.1007/s00268-016-3460-yISI: 000377775100027PubMedID: 26913728OAI: oai:DiVA.org:oru-51139DiVA: diva2:945471
Funder
Swedish Research Council, 09101
Note

Funding Agencies:

Stockholm County Council (SLL)

Hans Mellström foundation

Erling-Persson Family Foundation, Nyckelfonden, Örebro, Sweden

Available from: 2016-07-01 Created: 2016-07-01 Last updated: 2017-10-17Bibliographically approved

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