Influence of the enhanced recovery after surgery protocol on postoperative inflammation and short-term postoperative surgical outcomes after colorectal cancer surgery

Heba Essam Jalloun, In Kyu Lee, Min Ki Kim, Na Young Sung, Suhail Abdullah Al Turkistani, Sun Min Park, Dae Youn Won, Sang Hyun Hong, Bong Hyeon Kye, Yoon Suk Lee, Hae Myung Jeon

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Purpose: Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improve postoperative surgical outcomes. The purpose of this study was to observe the effects on postoperative inflammatory markers and to explore the effects of a high degree of compliance and the use of epidural anesthesia on inflammation and surgical outcomes. Methods: Four hundred patients underwent colorectal cancer surgery at 2 hospitals during 2 different periods, namely, from January 2006 to December 2009 and from January 2017 to July 2017. Data related to the patient's clinicopathological features, inflammatory markers, percentage of compliance with elements of the ERAS protocol, and use of epidural anesthesia were collected from a prospectively maintained database. Results: The complication rate and the length of hospital stay (LOS) were less in the ERAS group than in the conventional group (P=0.005 and P≤0.001, respectively). The postoperative white blood cell count and the duration required for leukocytes to normalize were reduced in patients following the ERAS protocol (P≤0.001). Other inflammatory markers, such as lymphocyte count (P=0.008), neutrophil/lymphocyte ratio (P=0.032), and C-reactive protein level (P≤0.001), were lower in the ERAS protocol group. High compliance (≥70%) was strongly associated with the complication rate and the LOS (P= 0.008 and P≤0.001, respectively). Conclusion: ERAS protocols decrease early postoperative inflammation and improves short-term postoperative recovery outcomes such as complication rate and the LOS. High compliance (≥70%) with the ERAS protocol elements accelerates the positive effects of ERAS on surgical outcomes; however, the effect on inflammation was very small.

Original languageEnglish
Pages (from-to)264-272
Number of pages9
JournalAnnals of Coloproctology
Volume36
Issue number4
DOIs
StatePublished - 31 Aug 2020

Bibliographical note

Funding Information:
This research was supported by Research Fund of The Catholic University of Korea, Seoul St. Mary’s Hospital.

Funding Information:
This research was supported by Research Fund of The Catholic University of Korea, Seoul St. Mary's Hospital.

Publisher Copyright:
© 2020 The Korean Society of Coloproctology This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords

  • Colorectal neoplasms
  • Enhanced recovery after surgery
  • Inflammation, Length of stay
  • Laparoscopy

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