Skip to main content
Top
Published in: Langenbeck's Archives of Surgery 7/2020

01-11-2020 | Colon Cancer | Original Article

The factors related to failure of Enhanced Recovery after Surgery (ERAS) in colon cancer surgery

Authors: Jian-Sheng Chen, Si-Da Sun, Zhi-Sheng Wang, Tian-Hong Cai, Long-Kai Huang, Wen-Xing Sun, Chang-Qing Lin, Jun-Feng Zhou, Jia-Xing Wang, Qing-Liang He

Published in: Langenbeck's Archives of Surgery | Issue 7/2020

Login to get access

Abstract

Purpose

Enhanced Recovery after Surgery has been proven effective for patients with gastrointestinal cancer. But radical enhanced recovery could also lead to adverse clinical outcomes. Compared with reports on the estimation of successful implementation of enhanced recovery, studies on risk factors of enhanced recovery failure are still lacking.

Methods

A retrospective analysis was carried out on 102 patients in ERAS who underwent elective colon cancer surgery. This study included 102 patients with colon cancer between 2015 and 2019, defining enhanced recovery failure as postoperative length of stay over 10 days, stay in ICU over 24 h after surgery, reoperation, death, or unplanned readmission within 30 days after surgery. Univariate and multivariate analyses were performed to explore potential risk factors of failure.

Results

Aged ≥ 75, open operation, number of drainage tube over 1, re-urethral catheterization, and Clavien-Dindo grade over 2 were associated with ERAS failure, according to univariate analysis. Multivariate analysis showed that age ≥ 75 [OR 7.231; P = 0.009]; open operation (OR 3.599; P = 0.021); and number of drainage tube over 1 (OR 3.202; P = 0.020) were independent risk factors for ERAS failure.

Conclusions

We found age ≥ 75, open operation, and number of drainage tube over 1 are independent risk factors associated with ERAS failure after colon cancer surgery.
Literature
1.
go back to reference Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322:473–476CrossRef Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322:473–476CrossRef
2.
go back to reference Chestovich PJ, Lin AY, Yoo J (2003) Fast-track pathways in colorectal surgery. Surg Clin N Am 93:21–32CrossRef Chestovich PJ, Lin AY, Yoo J (2003) Fast-track pathways in colorectal surgery. Surg Clin N Am 93:21–32CrossRef
3.
go back to reference Bosio RM, Smith BM, Aybar PS, Senagore AJ (2007) Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise. Am J Surg 193:413–415CrossRef Bosio RM, Smith BM, Aybar PS, Senagore AJ (2007) Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise. Am J Surg 193:413–415CrossRef
4.
go back to reference Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198CrossRef Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198CrossRef
5.
go back to reference 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 56:667–678CrossRef 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 56:667–678CrossRef
6.
go back to reference Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJHM (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD007635 Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJHM (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD007635
7.
go back to reference Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt M, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH, Enhanced Recovery After Surgery (ERAS) Group (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery after Surgery (ERAS) group recommendations. Arch Surg 144:961–969CrossRef Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt M, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH, Enhanced Recovery After Surgery (ERAS) Group (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery after Surgery (ERAS) group recommendations. Arch Surg 144:961–969CrossRef
8.
go back to reference Feroci F, Lenzi E, Baraghini M, Garzi A, Vannucchi A, Cantafio S, Scatizzi M (2013) Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech 23:259–265CrossRef Feroci F, Lenzi E, Baraghini M, Garzi A, Vannucchi A, Cantafio S, Scatizzi M (2013) Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech 23:259–265CrossRef
9.
go back to reference Smart NJ, White P, Allison AS, Ockrim JB, Kennedy RH, Francis NK (2012) Deviation and failure of Enhanced Recovery after Surgery following laparoscopic colorectal surgery: early prediction model. Color Dis 14:727–734CrossRef Smart NJ, White P, Allison AS, Ockrim JB, Kennedy RH, Francis NK (2012) Deviation and failure of Enhanced Recovery after Surgery following laparoscopic colorectal surgery: early prediction model. Color Dis 14:727–734CrossRef
10.
go back to reference Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef
11.
go back to reference Lewis DR, Chen HS, Cockburn MG, Wu XC, Stroup AM, Midthune DN, Zou Z, Krapcho MF, Miller DG, Feuer EJ (2017) Early estimates of SEER cancer incidence, 2014. Cancer 123:2524–2534CrossRef Lewis DR, Chen HS, Cockburn MG, Wu XC, Stroup AM, Midthune DN, Zou Z, Krapcho MF, Miller DG, Feuer EJ (2017) Early estimates of SEER cancer incidence, 2014. Cancer 123:2524–2534CrossRef
12.
go back to reference Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96CrossRef Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96CrossRef
13.
go back to reference Alley PG (2000) Surgery for colorectal cancer in elderly patients. Lancet 356:956CrossRef Alley PG (2000) Surgery for colorectal cancer in elderly patients. Lancet 356:956CrossRef
14.
go back to reference Temple LK, Hsieh L, Wong WD et al (2004) Use of surgery among elderly patients with stage IV colorectal cancer. J Clin Oncol 22:3475–3484CrossRef Temple LK, Hsieh L, Wong WD et al (2004) Use of surgery among elderly patients with stage IV colorectal cancer. J Clin Oncol 22:3475–3484CrossRef
15.
go back to reference Papamichael D, Audisio R, Horiot JC, Glimelius B, Sastre J, Mitry E, van Cutsem E, Gosney M, Köhne CH, Aapro M, SIOG (2009) Treatment of the elderly colorectal cancer patient: SIOG expert recommendations. Ann Oncol 20:5–16CrossRef Papamichael D, Audisio R, Horiot JC, Glimelius B, Sastre J, Mitry E, van Cutsem E, Gosney M, Köhne CH, Aapro M, SIOG (2009) Treatment of the elderly colorectal cancer patient: SIOG expert recommendations. Ann Oncol 20:5–16CrossRef
16.
go back to reference Yamamoto S, Hinoi T, Niitsu H et al (2017) Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: subanalysis of a large multicenter study in Japan. J Gastroenterol 52:695–704CrossRef Yamamoto S, Hinoi T, Niitsu H et al (2017) Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: subanalysis of a large multicenter study in Japan. J Gastroenterol 52:695–704CrossRef
17.
go back to reference Jafari MD, Jafari F, Halabi WJ, Nguyen VQ, Pigazzi A, Carmichael JC, Mills SD, Stamos MJ (2014) Colorectal cancer resections in the aging US population a trend toward decreasing rates and improved outcomes. JAMA Surg 149:557–564CrossRef Jafari MD, Jafari F, Halabi WJ, Nguyen VQ, Pigazzi A, Carmichael JC, Mills SD, Stamos MJ (2014) Colorectal cancer resections in the aging US population a trend toward decreasing rates and improved outcomes. JAMA Surg 149:557–564CrossRef
18.
go back to reference Wagman LD (2007) Laparoscopic and open surgery for colorectal cancer: reaching equipoise? J Clin Oncol 25:2996–2998CrossRef Wagman LD (2007) Laparoscopic and open surgery for colorectal cancer: reaching equipoise? J Clin Oncol 25:2996–2998CrossRef
19.
go back to reference Greene FL (1999) Laparoscopic management of colorectal cancer. CA Cancer J Clin 49:221–228CrossRef Greene FL (1999) Laparoscopic management of colorectal cancer. CA Cancer J Clin 49:221–228CrossRef
20.
go back to reference Marcello PW (2000) Laparoscopic colorectal surgery. Gastroenterology 118:806CrossRef Marcello PW (2000) Laparoscopic colorectal surgery. Gastroenterology 118:806CrossRef
21.
go back to reference Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRef Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRef
22.
go back to reference Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328CrossRef Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328CrossRef
23.
go back to reference Nelson H, Sargent DJ, Wieand HS et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef Nelson H, Sargent DJ, Wieand HS et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
24.
go back to reference Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRef Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRef
25.
go back to reference Sun J, Qiu ZJ (2011) A non-randomized perspective investigation on long-term outcomes comparison between laparoscopic and open surgery in the treatment of colon cancer. Fudan Univ J Med Sci 03:211–215 Sun J, Qiu ZJ (2011) A non-randomized perspective investigation on long-term outcomes comparison between laparoscopic and open surgery in the treatment of colon cancer. Fudan Univ J Med Sci 03:211–215
26.
go back to reference Kennedy RH, Francis EA, Wharton R, Blazeby JM, Quirke P, West NP, Dutton SJ (2014) Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol 32:1804–1812CrossRef Kennedy RH, Francis EA, Wharton R, Blazeby JM, Quirke P, West NP, Dutton SJ (2014) Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol 32:1804–1812CrossRef
27.
go back to reference Robinson JO (1986) Surgical drainage: an historical perspective. Br J Surg 73:422–426CrossRef Robinson JO (1986) Surgical drainage: an historical perspective. Br J Surg 73:422–426CrossRef
28.
go back to reference Sagar PM, Couse N, Kerin M, May J, Macfie J (1993) Randomized trial of drainage of colorectal anastomosis. Br J Surg 80:769–771CrossRef Sagar PM, Couse N, Kerin M, May J, Macfie J (1993) Randomized trial of drainage of colorectal anastomosis. Br J Surg 80:769–771CrossRef
29.
go back to reference Tsujinaka S, Konishi F (2011) Drain vs no drain after colorectal surgery. Indian J Surg Oncol 2:3–8CrossRef Tsujinaka S, Konishi F (2011) Drain vs no drain after colorectal surgery. Indian J Surg Oncol 2:3–8CrossRef
30.
go back to reference Rondelli F, Bugiantella W, Vedovati MC et al (2014) To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta-analysis. Color Dis 16:35–42CrossRef Rondelli F, Bugiantella W, Vedovati MC et al (2014) To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta-analysis. Color Dis 16:35–42CrossRef
31.
go back to reference Urbach DR, Kennedy ED, Cohen MM et al (1999) Colon and rectal anastomoses do not require routine drainage. Ann Surg 229:174–180CrossRef Urbach DR, Kennedy ED, Cohen MM et al (1999) Colon and rectal anastomoses do not require routine drainage. Ann Surg 229:174–180CrossRef
32.
go back to reference Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery. Ann Surg 240:1074–1084CrossRef Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery. Ann Surg 240:1074–1084CrossRef
33.
go back to reference Foster ME (2017) To drain or not after colorectal surgery. Ann R CON Surg Engl 70:158–160 Foster ME (2017) To drain or not after colorectal surgery. Ann R CON Surg Engl 70:158–160
34.
go back to reference Emile SH, Abd El-Hamed TM (2017) Routine drainage of colorectal anastomoses: an evidence-based review of the current literature. Gastroenterol Res Pract 2017:1–7CrossRef Emile SH, Abd El-Hamed TM (2017) Routine drainage of colorectal anastomoses: an evidence-based review of the current literature. Gastroenterol Res Pract 2017:1–7CrossRef
35.
go back to reference Schreiber A, Aydil E, Walschus U, Glitsch A, Patrzyk M, Heidecke C-D, Schulze T (2019) Early removal of urinary drainage in patients receiving epidural analgesia after colorectal surgery within an ERAS protocol is feasible. Langenbeck's Arch Surg 404:853–863CrossRef Schreiber A, Aydil E, Walschus U, Glitsch A, Patrzyk M, Heidecke C-D, Schulze T (2019) Early removal of urinary drainage in patients receiving epidural analgesia after colorectal surgery within an ERAS protocol is feasible. Langenbeck's Arch Surg 404:853–863CrossRef
36.
go back to reference Sun SD, Wu PP, Zhou JF, Wang JX, He QL (2020) Failure of Enhanced Recovery after Surgery in laparoscopic colorectal surgery: a systematic review. Int J Color Dis 35:1007–1014CrossRef Sun SD, Wu PP, Zhou JF, Wang JX, He QL (2020) Failure of Enhanced Recovery after Surgery in laparoscopic colorectal surgery: a systematic review. Int J Color Dis 35:1007–1014CrossRef
37.
go back to reference Crouzet J, Bertrand X, Venier AG, Badoz M, Husson C, Talon D (2007) Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. J Hosp Infect 67:253–257CrossRef Crouzet J, Bertrand X, Venier AG, Badoz M, Husson C, Talon D (2007) Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. J Hosp Infect 67:253–257CrossRef
38.
go back to reference Collard MK, Anyla M, Lefevre JH et al (2020) Patients’ refusal as major limitation of early discharge after colorectal resection in an enhanced recovery program. Langenbeck's Arch Surg 405:337–344CrossRef Collard MK, Anyla M, Lefevre JH et al (2020) Patients’ refusal as major limitation of early discharge after colorectal resection in an enhanced recovery program. Langenbeck's Arch Surg 405:337–344CrossRef
Metadata
Title
The factors related to failure of Enhanced Recovery after Surgery (ERAS) in colon cancer surgery
Authors
Jian-Sheng Chen
Si-Da Sun
Zhi-Sheng Wang
Tian-Hong Cai
Long-Kai Huang
Wen-Xing Sun
Chang-Qing Lin
Jun-Feng Zhou
Jia-Xing Wang
Qing-Liang He
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 7/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-020-01975-z

Other articles of this Issue 7/2020

Langenbeck's Archives of Surgery 7/2020 Go to the issue