Application of enhanced recovery after surgery in elderly patients with colorectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Ziwen ¹ , XI Xiaonan ² , LIU Zhaoli ³ , LI Dalue ¹ , WANG Shunzheng ¹ , XU Jihua ¹ , ZHANG Xunying ¹ ,  WANG Dongsheng ¹

1. Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P. R. China;
2. Department of Pathology, Shouguang People’s Hospital, Weifang, Shandong 262700, P. R. China;
3. Department of General Surgery, Luzhong Hospital, Peking University, Zibo, Shandong 255400, P. R. China;

Corresponding author：

WANG Dongsheng, Email: wangds0538@hotmail.com

Keywords：

enhanced recovery after surgery; colorectal cancer; elderly patient

DOI：

10.7507/1007-9424.201809040

Video：

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Objective To observe the clinical effect of enhanced recovery after surgery (ERAS) in elderly patients with right colon cancer. Methods A total of 90 elderly patients who were diagnosed as right colon cancer and underwent radical resection of right colon cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Qingdao University from April 2018 to October 2018 were enrolled prospectively. These patients were randomly divided into two groups: ERAS group (n=44) receiving ERAS during perioperative period and control group (n=46) undergoing conventional surgical treatment. To compare the occurrence of postoperative complications, the recovery of gastrointestinal function, and the changes of serum inflammatory factors between the two groups before and after operation. Results ① There was no significant difference in the incidence of total postoperative complications and the incidence of complications (including anastomotic leakage, incision infection, postoperative bleeding, intestinal obstruction, cardiovascular complications, pulmonary infection, and urethral infection） between the ERAS group and the control group (P>0.05). ② The first anal exhaust time, postoperative fever time, postoperative hospitalization time, quality of life score, and hospitalization cost of the ERAS group were better than those of the control group (P<0.05). ③ There were no significant difference in serum IL-6, TNF-α, and CRP levels between the two groups before operation (P>0.05), but on the 1^st and 3^rd day after operation, the three indexes of the control group were higher than those of the ERAS group (P<0.05). Conclusion The application of the idea of ERAS in the elderly patients with right colon cancer can promote the recovery of gastrointestinal function, shorten the hospitalization time, and improve the clinical outcome.

Citation： ZHAO Ziwen, XI Xiaonan, LIU Zhaoli, LI Dalue, WANG Shunzheng, XU Jihua, ZHANG Xunying, WANG Dongsheng. Application of enhanced recovery after surgery in elderly patients with colorectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(1): 77-81. doi: 10.7507/1007-9424.201809040 Copy

1.	Baek SJ, Kim SH, Kim SY, et al. The safety of a " fast-track” program after laparoscopic colorectal surgery is comparable in older patients as in younger patients. Surg Endosc, 2013, 27(4): 1225-1232.
2.	Cakir H, van Stijn MF, Lopes Cardozo AM, et al. Adherence to Enhanced Recovery After Surgery and length of stay after colonic resection. Colorectal Dis, 2013, 15(8): 1019-1025.
3.	Bagnall NM, Malietzis G, Kennedy RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis, 2014, 16(12): 947-956.
4.	Lin HS, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr, 2016, 16(1): 157.
5.	Bakker N, Cakir H, Doodeman HJ, et al. Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: impact of measures to improve adherence. Surgery, 2015, 157(6): 1130-1136.
6.	Pawa N, Cathcart PL, Arulampalam TH, et al. Enhanced recovery program following colorectal resection in the elderly patient. World J Surg, 2012, 36(2): 415-423.
7.	Ren L, Zhu D, Wei Y, et al. Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg, 2012, 36(2): 407-414.
8.	Grant MC, Hanna A, Benson A, et al. Dedicated operating room teams and clinical outcomes in an enhanced recovery after surgery pathway for colorectal surgery. J Am Coll Surg, 2018, 226(3): 267-276.
9.	Beamish AJ, Chan DS, Blake PA, et al. Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery. Int J Surg, 2015, 19: 46-54.
10.	Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
11.	Kobayashi D, Kodera Y, Fujiwara M, et al. Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World J Surg, 2011, 35(2): 357-364.
12.	Keller DS, Lawrence JK, Nobel T, et al. Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc, 2013, 27(12): 4463-4468.
13.	Joseph B, Pandit V, Sadoun M, et al. Frailty in surgery. J Trauma Acute Care Surg, 2014, 76(4): 1151-1156.
14.	Gustafsson UO, Tiefenthal M, Thorell A, et al. Laparoscopic-assisted and open high anterior resection within an ERAS protocol. World J Surg, 2012, 36(5): 1154-1161.
15.	van Zelm R, Coeckelberghs E, Sermeus W, et al. Variation in care for surgical patients with colorectal cancer: protocol adherence in 12 European hospitals. Int J Colorectal Dis, 2017, 32(10): 1471-1478.
16.	Slieker J, Frauche P, Jurt J, et al. Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery. Int J Colorectal Dis, 2017, 32(2): 215-221.
17.	Ruiz-Tovar J, Garcia A, Ferrigni C, et al. Laparoscopic-guided transversus abdominis plane (TAP) block as part of multimodal analgesia in laparoscopic Roux-en-Y gastric bypass within an enhanced recovery after surgery (ERAS) program: a prospective randomized clinical trial. Obes Surg, 2018, 28(11): 3374-3379.
18.	Gonzalez-Ayora S, Pastor C, Guadalajara H, et al. Enhanced recovery care after colorectal surgery in elderly patients. com- pliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Colorectal Dis, 2016, 31(9): 1625-1631.
19.	Hahl T, Peromaa-Haavisto P, Tarkiainen P, et al. Outcome of laparoscopic gastric bypass (LRYGB) with a program for enhanced recovery after surgery (ERAS). Obes Surg, 2016, 26(3): 505-511.
20.	Pędziwiatr M, Kisialeuski M, Wierdak M, et al. Early implementation of enhanced recovery after surgery (ERAS®) protocol-compliance improves outcomes: a prospective cohort study. Int J Surg, 2015, 21: 75-81.
21.	Fumagalli Romario U, Weindelmayer J, Coratti A, et al. Enhanced recovery after surgery in gastric cancer: which are the main achievements from the Italian experience? Updates Surg, 2018, 70(2): 257-254.
22.	Pawelec G, Larbi A. Immunity and ageing in man: annual review 2006/2007. Exp Gerontol, 2008, 43(1): 34-38.
23.	王帅, 邱远, 江恩来, 等. 从手术应激的角度看加速康复外科. 中国普外基础与临床杂志, 2018, 25(7): 878-882.
24.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
25.	邓珍君, 方超, 汪晓东, 等. 炎症因子在结直肠癌术后并发症早期预测方面的应用进展. 四川医学, 2012, 33(5): 890-892.
26.	Sitkin SI, Kolgushkin GA, Shishko IuK, et al. Case of successful thrombolytic therapy in complex cardio-pulmonary resuscitation for massive pulmonary thromboembolism in parturient after elective caesarian operation. Anesteziol Reanimatol, 2013, (6): 54-56.

1. Baek SJ, Kim SH, Kim SY, et al. The safety of a " fast-track” program after laparoscopic colorectal surgery is comparable in older patients as in younger patients. Surg Endosc, 2013, 27(4): 1225-1232.
2. Cakir H, van Stijn MF, Lopes Cardozo AM, et al. Adherence to Enhanced Recovery After Surgery and length of stay after colonic resection. Colorectal Dis, 2013, 15(8): 1019-1025.
3. Bagnall NM, Malietzis G, Kennedy RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis, 2014, 16(12): 947-956.
4. Lin HS, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr, 2016, 16(1): 157.
5. Bakker N, Cakir H, Doodeman HJ, et al. Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: impact of measures to improve adherence. Surgery, 2015, 157(6): 1130-1136.
6. Pawa N, Cathcart PL, Arulampalam TH, et al. Enhanced recovery program following colorectal resection in the elderly patient. World J Surg, 2012, 36(2): 415-423.
7. Ren L, Zhu D, Wei Y, et al. Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg, 2012, 36(2): 407-414.
8. Grant MC, Hanna A, Benson A, et al. Dedicated operating room teams and clinical outcomes in an enhanced recovery after surgery pathway for colorectal surgery. J Am Coll Surg, 2018, 226(3): 267-276.
9. Beamish AJ, Chan DS, Blake PA, et al. Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery. Int J Surg, 2015, 19: 46-54.
10. Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
11. Kobayashi D, Kodera Y, Fujiwara M, et al. Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World J Surg, 2011, 35(2): 357-364.
12. Keller DS, Lawrence JK, Nobel T, et al. Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc, 2013, 27(12): 4463-4468.
13. Joseph B, Pandit V, Sadoun M, et al. Frailty in surgery. J Trauma Acute Care Surg, 2014, 76(4): 1151-1156.
14. Gustafsson UO, Tiefenthal M, Thorell A, et al. Laparoscopic-assisted and open high anterior resection within an ERAS protocol. World J Surg, 2012, 36(5): 1154-1161.
15. van Zelm R, Coeckelberghs E, Sermeus W, et al. Variation in care for surgical patients with colorectal cancer: protocol adherence in 12 European hospitals. Int J Colorectal Dis, 2017, 32(10): 1471-1478.
16. Slieker J, Frauche P, Jurt J, et al. Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery. Int J Colorectal Dis, 2017, 32(2): 215-221.
17. Ruiz-Tovar J, Garcia A, Ferrigni C, et al. Laparoscopic-guided transversus abdominis plane (TAP) block as part of multimodal analgesia in laparoscopic Roux-en-Y gastric bypass within an enhanced recovery after surgery (ERAS) program: a prospective randomized clinical trial. Obes Surg, 2018, 28(11): 3374-3379.
18. Gonzalez-Ayora S, Pastor C, Guadalajara H, et al. Enhanced recovery care after colorectal surgery in elderly patients. com- pliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Colorectal Dis, 2016, 31(9): 1625-1631.
19. Hahl T, Peromaa-Haavisto P, Tarkiainen P, et al. Outcome of laparoscopic gastric bypass (LRYGB) with a program for enhanced recovery after surgery (ERAS). Obes Surg, 2016, 26(3): 505-511.
20. Pędziwiatr M, Kisialeuski M, Wierdak M, et al. Early implementation of enhanced recovery after surgery (ERAS®) protocol-compliance improves outcomes: a prospective cohort study. Int J Surg, 2015, 21: 75-81.
21. Fumagalli Romario U, Weindelmayer J, Coratti A, et al. Enhanced recovery after surgery in gastric cancer: which are the main achievements from the Italian experience? Updates Surg, 2018, 70(2): 257-254.
22. Pawelec G, Larbi A. Immunity and ageing in man: annual review 2006/2007. Exp Gerontol, 2008, 43(1): 34-38.
23. 王帅, 邱远, 江恩来, 等. 从手术应激的角度看加速康复外科. 中国普外基础与临床杂志, 2018, 25(7): 878-882.
24. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
25. 邓珍君, 方超, 汪晓东, 等. 炎症因子在结直肠癌术后并发症早期预测方面的应用进展. 四川医学, 2012, 33(5): 890-892.
26. Sitkin SI, Kolgushkin GA, Shishko IuK, et al. Case of successful thrombolytic therapy in complex cardio-pulmonary resuscitation for massive pulmonary thromboembolism in parturient after elective caesarian operation. Anesteziol Reanimatol, 2013, (6): 54-56.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of enhanced recovery after surgery in elderly patients with colorectal cancer

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