title: Laparoscopic and open right-sided colonic resection in daily routine practice. A prospective multicentre study within an Enhanced Recovery After Surgery (ERAS) protocol.
abstract: OBJECTIVE
  The study compared the outcome of laparoscopic and open surgery in daily practice when performed in a strict Enhanced Recovery After Surgery (ERAS) environment.
  
  
  METHODS
  Two-hundred and ninety-two consecutive patients who received elective surgery, in three Swedish ERAS centres, for cancer or adenoma in the right colon in the period 1 January 2011 to 31 December 2012, were prospectively registered in a Web-based ERAS database. Peri-operative data were collected from the database and patient charts. The primary end-points included postoperative recovery and morbidity. The secondary objective was to identify preoperative variables that influenced the selection of patients for laparoscopic or open surgery.
  
  
  RESULTS
  One-hundred and twenty-three (42%) patients were selected for laparoscopic surgery. The overall preoperative ERAS-compliance rate was 87% and no significant difference was seen between the surgical techniques. In multivariate analysis, patients treated with laparoscopy had significantly earlier pain control (2.4 ± 3.2 days vs 4.2 ± 5.9 days; P = 0.016) and a shorter length of hospital stay (LOS) (4 days vs 6 days; P = 0.002) compared with open surgery. There was no significant difference in the complication rate [18.7% vs 21.3%; OR = 1.0 (95% CI: 0.5-2.0)], the number of lymph nodes removed or the rate of R0 resection between laparoscopic and open surgery. Tumours selected for laparoscopy were generally smaller, had a lower T-stage and were predominantly situated in the caecum and the ascending colon compared with those of patients selected for open surgery.
  
  
  CONCLUSIONS
  The use of laparoscopy in routine right-sided colectomy in an ERAS environment, with data on outcome corrected for selection bias, may result in faster recovery compared with open surgery.
authors.affiliation: Department of Surgery, Ersta Hospital, Stockholm, Sweden.|Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Tiefenthal
authors.affiliation: Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Asklid
authors.affiliation: Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Hjern
authors.affiliation: Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Matthiessen
authors.affiliation: Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: U O
authors.initials: UO
authors.lastname: Gustafsson
mesh_terms: D002985:Clinical Protocols; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D003106:Colon / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D007902:Length of Stay; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D059408:Pain Management; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000534:rehabilitation; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function; D013548:Sweden; D016896:Treatment Outcome
keywords: ERAS; colorectal surgery; laparoscopic surgery