title: The introduction of early patient rehabilitation in surgery of soft tissue sarcoma and its impact on post-operative outcome.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) programs are implemented in multiple fields of surgery, but not yet in soft-tissue sarcoma (STS) surgery. We wondered whether its introduction into STS surgery might have impacted postoperative outcome.
  
  
  METHODS
  Two hundred and fifty seven adult patients with primary limb or trunk wall STS received ERAS from 2008 to 2012 as a part of the intra-operative management. We evaluated, in retrospect, the intra-operative management, post-operative outcomes, functional and oncological results of these patients and compared them with 459 prior patients treated under a standard recovery after surgery (SRAS) program from 1989 to 2007.
  
  
  RESULTS
  The most visible change from SRAS to ERAS in the perioperative management was decrease of wound drainage (72% vs. 15%, p < 0.001) and increase of wound bandaging (16% vs. 66%; p < 0.001), underlining the appliance of the ERAS protocol. Post-operatively, hospital stay dropped from nine (0-74) to three (0-22) days (p < 0.001) without affecting major morbidity (8% vs. 5%, NS) or readmission to the hospital (5% vs. 4%, NS). Functional outcome improved (p = 0.009) but whether this change was due to ERAS remains to be proved because complementary treatments changed over time. Tumour control remained unaffected, with an estimated risk of local recurrence at 5 years of 12% in both groups.
  
  
  CONCLUSIONS
  Introducing a rapid recovery program was associated with a shorter hospitalization stay without compromising surgical or oncological outcomes. The program appears to be safe and reliable to use in patients undergoing STS surgery.
authors.affiliation: Department of Surgery, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Michot
authors.affiliation: Department of Surgery, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France. Electronic address: e.stoeckle@bordeaux.unicancer.fr.
authors.forename: E
authors.initials: E
authors.lastname: Stoeckle
authors.affiliation: Department of Physiotherapy and Re-education, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France.
authors.forename: J-D
authors.initials: JD
authors.lastname: Bannel
authors.affiliation: Department of Anaesthesia and Reanimation, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France.
authors.forename: S
authors.initials: S
authors.lastname: Colombani
authors.affiliation: Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France.
authors.forename: P
authors.initials: P
authors.lastname: Sargos
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Brouste
authors.affiliation: Department of Medical Oncology, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Italiano
authors.affiliation: Department of Medical Imaging, Institut Bergonié, 229 cours de l'Argonne, F-33076 Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Kind
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000534:rehabilitation*; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D020127:Recovery of Function; D012509:Sarcoma / Q000534:rehabilitation*; D013997:Time Factors; D055815:Young Adult
keywords: Enhanced recovery after surgery; Fast-track; Functional outcome; Morbidity; Soft-tissue sarcoma; Surgery