Abstract
Purpose
Enhanced recovery after surgery (ERAS) improves outcomes after elective colorectal operations. Whether it is beneficial for emergency colorectal surgery is unclear. This study aimed to systematically review and summarize evidence from all studies comparing ERAS versus conventional care in patients having emergency colectomy and/or proctectomy for obstructive colorectal cancer.
Methods
EMBASE, MEDLINE, and PUBMED from 1981 to December 2019 were systematically searched. Any studies comparing our primary outcome of interest (length of hospitalization) among patients having emergency resection for obstructive colorectal cancer who received ERAS versus conventional care were selected. Primary outcome was length of hospitalization. Secondary outcomes were gastrointestinal recovery, postoperative complication, 30-day readmission and mortality, and time to start adjuvant therapy.
Results
Three cohort studies with 818 participants (418 received ERAS and 400 received conventional care) were included. Length of hospitalization (mean reduction 3.07 days; 95% CI, − 3.91 to − 2.23) and risk of overall complication (risk ratio 0.78; 95% CI, 0.63 to 0.97) were significantly lower in ERAS than in conventional care. ERAS was also associated with quicker time to gastrointestinal recovery, a lower incidence of ileus, and a shorter interval between operation and commence of adjuvant chemotherapy. There was no significant difference in the rates of anastomotic leakage, surgical site infection, reoperation, readmission, and mortality within 30 days after surgery between groups.
Conclusions
ERAS had advantages over conventional care in patients undergoing emergency resection for obstructive colorectal cancer—including a shorter length of hospitalization, a lower incidence of overall complication, and a quicker gastrointestinal recovery.
Similar content being viewed by others
Data availability
All data analyzed during this study are included in this published article.
References
Barrow E, Anderson ID, Varley S, Pichel AC, Peden CJ, Saunders DI, Murray D (2013) Current UK practice in emergency laparotomy. Ann R Coll Surg Engl 95:599–603
Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, Salim A, Havens JM (2016) Use of national burden to define operative emergency general surgery. JAMA Surg 151:e160480
Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, Agresta F, Allievi N, Bellanova G, Coccolini F, Coy C, Fugazzola P, Martinez CA, Montori G, Paolillo C, Penachim TJ, Pereira B, Reis T, Restivo A, Rezende-Neto J, Sartelli M, Valentino M, Abu-Zidan FM, Ashkenazi I, Bala M, Chiara O, De’ Angelis N, Deidda S, De Simone B, Di Saverio S, Finotti E, Kenji I, Moore E, Wexner S, Biffl W, Coimbra R, Guttadauro A, Leppaniemi A, Maier R, Magnone S, Mefire AC, Peitzmann A, Sakakushev B, Sugrue M, Viale P, Weber D, Kashuk J, Fraga GP, Kluger I, Catena F, Ansaloni L (2018) 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 13:36
Aquina CT, Becerra AZ, Xu Z, Boscoe FP, Schymura MJ, Noyes K, Monson JRT, Fleming FJ (2017) Nonelective colon cancer resection: a continued public health concern. Surgery 161:1609–1618
Kulaylat AS, Pappou E, Philp MM, Kuritzkes BA, Ortenzi G, Hollenbeak CS, Choi C, Messaris E (2019) Emergent colon resections: does surgeon specialization influence outcomes? Dis Colon Rectum 62:79–87
Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298
Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440
Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678
Greer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, Sultan S, Wilt TJ (2018) Enhanced recovery protocols for adults undergoing colorectal surgery: a systematic review and meta-analysis. Dis Colon Rectum 61:1108–1118
Lohsiriwat V (2014) Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol 20:13950–13955
Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, Miyamoto S, Inoue S, Umekita N (2017) Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg 17:18
Shang Y, Guo C, Zhang D (2018) Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer: a propensity score matching analysis. Medicine (Baltimore) 97:e12348
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700
Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2020) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Lohsiriwat V (2019) Enhanced recovery after surgery for emergency colorectal surgery: are there any differences between intra-abdominal infection and other indications? J Visc Surg 156:489–496
Barbieux J, Hamy A, Talbot MF, Casa C, Mucci S, Lermite E, Venara A (2017) Does enhanced recovery reduce postoperative ileus after colorectal surgery? J Visc Surg 154:79–85
Lau C, Phillips E, Bresee C, Fleshner P (2014) Early use of low residue diet is superior to clear liquid diet after elective colorectal surgery: a randomized controlled trial. Ann Surg 260:641–647
Lohsiriwat V (2019) Mosapride reduces prolonged postoperative ileus after open colorectal surgery in the setting of enhanced recovery after surgery (ERAS): a matched case-control study. Siriraj Med J 71:181–188
Zhang C, Yin S, Tan Y, Huang J, Wang P, Hou W, Zhang Z, Xu H (2020) Patient selection for adjuvant chemotherapy in high-risk stage II colon cancer: a systematic review and meta-analysis. Am J Clin Oncol 43:279–287
Strouch MJ, Zhou G, Fleshman JW, Birnbaum EH, Hunt SR, Mutch MG (2013) Time to initiation of postoperative chemotherapy: an outcome measure for patients undergoing laparoscopic resection for rectal cancer. Dis Colon Rectum 56:945–951
Yoshida Y, Aisu N, Kojima D, Mera T, Kiyomi F, Yamashita Y, Hasegawa S (2017) Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02). Ann Gastroenterol Surg 1:219–225
Gao P, Huang XZ, Song YX, Sun JX, Chen XW, Sun Y, Jiang YM, Wang ZN (2018) Impact of timing of adjuvant chemotherapy on survival in stage III colon cancer: a population-based study. BMC Cancer 18:234
Lohsiriwat V, Jitmungngan R (2019) Enhanced recovery after surgery in emergency colorectal surgery: review of literature and current practices. World J Gastrointest Surg 11:41–52
ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159
Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA, Sprangers MA, Cuesta MA, Bemelman WA, LAFA study group (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875
Author information
Authors and Affiliations
Contributions
VL and PU outlined the content. VL, RJ, and WC reviewed literature and collected data. VL and PU analyzed data and wrote the manuscript. RJ and WC critically reviewed the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethics approval
Not applicable. (The identity of the subjects under this systematic review and meta-analysis was omitted and anonymized.)
Consent to participate
Not applicable. (The identity of the subjects under this systematic review and meta-analysis was omitted and anonymized.)
Consent for publication
Not applicable. (The identity of the subjects under this systematic review and meta-analysis was omitted and anonymized.)
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lohsiriwat, V., Jitmungngan, R., Chadbunchachai, W. et al. Enhanced recovery after surgery in emergency resection for obstructive colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 35, 1453–1461 (2020). https://doi.org/10.1007/s00384-020-03652-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-020-03652-5