title: Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial.
abstract: BACKGROUND
  The aim of this trial was to compare the Enhanced Recovery After Surgery (ERAS) program with conventional perioperative management in patients who underwent radical resection for colorectal cancer.
  
  
  METHODS
  A combination of evidence-based and consensus methodology was used to develop the ERAS protocol. Five hundred ninety-seven consecutive patients who underwent elective colorectal resection were randomized to either the ERAS (n = 299) or the control group (n = 298). Outcomes relating to nutrition and metabolism index, stress index, and recovery index were measured and recorded.
  
  
  RESULTS
  Demographic and operative data were similar between the two groups. Patients in the ERAS group showed improved nutritional status when compared with those of the control group. On postoperative day (POD) 1, the HOMA-IR (insulin resistance index) of the ERAS group was lower than that of the control group (p < 0.001). The cortisol level of the control group was elevated on both POD 1 (p = 0.007) and POD 5 (p = 0.002) compared to the preoperative level. However, the cortisol level of the ERAS group was not increased until POD 5 (p = 0.001). Reduced levels of TNF-α, IL-1β, IL-6, and IFN-γ in the ERAS group indicated less postoperative stress responses. In addition, ERAS was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay (p < 0.001) and expense (p < 0.001) for the ERAS group were reduced in comparison to the controls. Twenty-eight cases in the control group and twenty-nine in the ERAS group suffered complications, which was not significantly different.
  
  
  CONCLUSIONS
  The ERAS protocol attenuates the surgical stress response and accelerates postoperative recovery without compromising patient safety.
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University Medical Center, Shanghai, 200032, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Ren
authors.forename: Dexiang
authors.initials: D
authors.lastname: Zhu
authors.forename: Ye
authors.initials: Y
authors.lastname: Wei
authors.forename: Xiangou
authors.initials: X
authors.lastname: Pan
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.forename: Jianmin
authors.initials: J
authors.lastname: Xu
authors.forename: Yunshi
authors.initials: Y
authors.lastname: Zhong
authors.forename: Zhanggang
authors.initials: Z
authors.lastname: Xue
authors.forename: Ling
authors.initials: L
authors.lastname: Jin
authors.forename: Shaokang
authors.initials: S
authors.lastname: Zhan
authors.forename: Weixin
authors.initials: W
authors.lastname: Niu
authors.forename: Xinyu
authors.initials: X
authors.lastname: Qin
authors.forename: Zhaohan
authors.initials: Z
authors.lastname: Wu
authors.forename: Zhaoguang
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D002985:Clinical Protocols; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D019990:Perioperative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function; D016037:Single-Blind Method; D013312:Stress, Physiological; D016896:Treatment Outcome
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