title: Laparoscopic-assisted and open high anterior resection within an ERAS protocol.
abstract: BACKGROUND
  Due to potentially superior short-term outcomes compared with open colorectal surgery, laparoscopic surgery is currently being implemented in clinical practice worldwide. In parallel, enhanced recovery after surgery (ERAS) programs are shown to improve postoperative recovery in open colorectal surgery. This study reports outcomes in laparoscopic versus open surgery in conjunction with compliance to the ERAS protocol.
  
  
  METHODS
  The association between surgical approach (laparoscopic or open surgery), compliance to the ERAS protocol, postoperative symptoms, complications, and length of stay after surgery was studied. Between January 2007 to December 2010, 114 consecutive patients underwent elective high anterior resection with laparoscopic-assisted (n = 55) or open resection (n = 59). All clinical data (114 variables) were prospectively recorded.
  
  
  RESULTS
  The overall preoperative ERAS-protocol compliance was 77% for both the laparoscopic and open group. Laparoscopic surgery resulted in shorter total length of stay (median 4 vs. 6 days, p = 0.04), earlier pain control (median 2 vs. 3 days, p = 0.008), shorter need for intravenous infusions, improved mobilization on the first postoperative day (POD1), and lower inflammatory response (CRP (POD1) 54 ± 24 vs. 67 ± 31 mg/l, p = 0.017) compared with open resection. The trends in fewer postoperative complications (9.1 vs. 16.9%; odds ratio (OR) 0.55; 95% confidence interval (CI) 0.17-1.81) and overall postoperative symptoms delaying recovery (20 vs. 30.5%; OR 0.63; 95% CI 0.22-1.34) in laparoscopic surgery were not statistically significant.
  
  
  CONCLUSIONS
  The use of laparoscopy in colorectal surgery within an ERAS protocol results in faster recovery compared with open resection.
authors.affiliation: Department of Surgery, Ersta Hospital, Stockholm, Sweden. ulf.gustafsson@erstadiakoni.se.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. ulf.gustafsson@erstadiakoni.se.|Centre for Gastrointestinal Disease, Ersta Hospital, Box 4622, 116 91, Stockholm, Sweden. ulf.gustafsson@erstadiakoni.se.
authors.forename: Ulf O
authors.initials: UO
authors.lastname: Gustafsson
authors.affiliation: Department of Surgery, Ersta Hospital, Stockholm, Sweden.|Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marit
authors.initials: M
authors.lastname: Tiefenthal
authors.affiliation: Department of Surgery, Ersta Hospital, Stockholm, Sweden.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Thorell
authors.affiliation: Department of Surgery, University Hospital, Örebro University, Örebro, Sweden.|Institute of Molecular Medicine and surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
authors.affiliation: Department of Surgery, Ersta Hospital, Stockholm, Sweden.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Nygrens
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome