title: Enhanced Recovery After Surgery (ERAS®) protocol in patients undergoing laparoscopic resection for stage IV colorectal cancer.
abstract: BACKGROUND
  There is strong evidence for the use of Enhanced Recovery After Surgery (ERAS) protocol with colorectal surgery. However, in most studies on ERAS, patients with stage IV colorectal cancer (CRC) are commonly excluded. It is not certain if the ERAS protocol combined with laparoscopy improves outcomes in this group of patients as well. The aim of the study is to assess the feasibility of the ERAS protocol implementation in patients operated laparoscopically due to stage IV CRC.
  
  
  METHODS
  A prospective analysis of patients undergoing laparoscopic colorectal surgery was performed. Group 1 included patients with stages I-III, and group 2 included patients with stage IV CRC. Demographic, surgical factors, length of stay (LOS), complications, readmissions, ERAS implementation and early postoperative recovery were compared between the groups.
  
  
  RESULTS
  Group 1 included 168 patients, and group 2 included 20 patients. There was no difference in the age, sex, BMI, ASA, cancer localisation or surgical parameters. No statistically significant difference was noted in complications (26.8 vs 20 %, p = 0.51344), LOS (4.7 vs 5.7 days, p = 0.28228) or readmissions (6 vs 10 %, p = 0.48392). The ERAS protocol compliance was 86.3 and 83.0 %, respectively (p = 0.17158).
  
  
  CONCLUSIONS
  Implementation of the ERAS protocol and laparoscopic surgery among patients with stage IV CRC is feasible and provides similar short-term clinical outcomes and recovery as with patients with stages I-III.
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. michal.pedziwiatr@uj.edu.pl.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. michal.pedziwiatr@uj.edu.pl.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. magdalenapisarska@interia.pl.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. magdalenapisarska@interia.pl.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pisarska
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. kisialeuskim@gmail.com.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. kisialeuskim@gmail.com.
authors.forename: Michał
authors.initials: M
authors.lastname: Kisielewski
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. majorpiotr@gmail.com.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. majorpiotr@gmail.com.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. maciej.matlok@uj.edu.pl.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. maciej.matlok@uj.edu.pl.
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. wierdakmateusz@op.pl.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. wierdakmateusz@op.pl.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Wierdak
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. mrnatk@gmail.com.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. mrnatk@gmail.com.
authors.forename: Michał
authors.initials: M
authors.lastname: Natkaniec
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. andrzej.budzynski@uj.edu.pl.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland. andrzej.budzynski@uj.edu.pl.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009367:Neoplasm Staging; D019990:Perioperative Care; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function