Application of enhanced recovery program after surgery(ERAS) in patients undergoing radical resection for colorectal cancer

Objective To compare the enhanced recovery program after surgery (ERAS) with conventional perioperative management in patients undergoing radical resection for colorectal cancer.Methods The ERAS protocol included a combination of evidence-based and consensus methodology.A total of 597 consecutive patients undergoing elective colorectal resection were randomized to either the ERAS(n=299) or the control group(n=298).Outcomes related to nutrition and metabolism index,stress index,and recovery index were measured and recorded.Results Demographics and operative parameters were similar between the two groups(P＞0.05),The nutritional status of patients in the ERAS group was improved after surgery compared with that of the control group.On postoperative day (POD) 1,the HOMA-IR in the ERAS group was significantly lower than that in the control group (P＜0.01).The cortisol level in the control group was elevated on both POD 1 (P＜0.01) and POD 5 (P＜0.01)compared to the preoperative level.However,the cortisol level was not increased until POD 5(P＜0.01) in the ERAS group.The levels of TNF-α,IL-1β,IL-6,and IFN-γ were reduced in the ERAS group,indicating less postoperative stress responses compared with the control group.In addition,ERAS group was associated with accelerated recovery of gastrointestinal function.The postoperative length of stay [(5.7±1.6) d vs.(6.6±2.4) d,P＜0.01] and expense[(15 998±2655) RMB vs.(17 763±3059) RMB,P＜0.01] were reduced in the ERAS group.Twenty-eight patients (9.4％) in the control group and 29 (9.7％) in the ERAS group developed complications,while the difference was not statistically significant (P＞0.05).Conclusion ERAS protocol alleviates surgical stress response and accelerates postoperative recovery without compromising patient safety. Key words: Colorectal neoplasms;  Surgical procedures;  Enhanced recovery program after surgery;  Stress