title: ERAS protocol in laparoscopic surgery for colonic versus rectal carcinoma: are there differences in short-term outcomes?
abstract: Most of the studies concerning enhanced recovery after surgery (ERAS) protocols in colorectal surgery include heterogeneous groups of patients undergoing open or laparoscopic surgery, both due to colonic and rectal cancer, thus creating a potential bias. The data investigating the differences between patients operated for either colonic or rectal cancer are sparse. The aim of the study was to compare short-term outcomes of laparoscopic surgery for colonic and rectal cancer with ERAS protocol. The analysis included consecutive prospectively registered patients operated for a colorectal cancer between January 2012 and September 2015. Patients were divided into two groups (colon vs. rectum). The measured outcomes were: length of stay (LOS), complication rate, readmission rate, compliance with ERAS protocol elements and recovery parameters (tolerance of early oral diet, mobilization and time to first flatus). Group 1 (colon) consisted of 150 patients and Group 2 (rectum) of 82 patients. Patients in Group 1 (150 patients) were discharged home earlier than in Group 2 (82 patients)-median LOS 4 versus 5 days, respectively. There was no statistical difference in complication rate (27.3 vs. 36.6 %) and readmissions (7.3 vs. 6.1 %). Compliance with the protocol was 86.9 and 82.6 %, respectively. However, in Group 1, the following procedures were used less frequently: bowel preparation (24 vs. 78.3 %) and postoperative drainage (23.3 vs. 71.0 %). There were no differences in recovery parameters between the groups. Univariate logistic regression showed that the type of surgery, drainage and stoma creation significantly prolonged LOS. In a multivariate logistic regression model, only a bowel preparation and drainage were shown to be significant. Although functional recovery and high compliance with ERAS protocol are possible irrespective of the type of surgery, laparoscopic rectal resections are associated with a longer LOS.
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland. michal.pedziwiatr@uj.edu.pl.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 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, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pisarska
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Kisielewski
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Mydlowska
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Rubinkiewicz
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Winiarski
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Colorectal cancer; Enhanced recovery after surgery; Fast-track surgery; Laparoscopy; Length of stay; Postoperative recovery