Safety and efficacy of an "enhanced recovery after surgery" protocol for patients undergoing colon cancer surgery: a multi-institutional controlled study.
OBJECTIVE
The aim of this multi-institutional study was to prospectively evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) protocol for colonic surgery.


METHODS
The subjects of this study were 320 patients with an American Society of Anesthesiologists (ASA) grade I or II physical status. Patients underwent elective open or laparoscopic colonic resection or high anterior resection between April 2011 and January 2014 at one of six institutions. Three hospitals implemented an ERAS protocol (n = 159), and three administered conventional care (n = 161). The primary outcome measure was the surgical complication rate.


RESULTS
Most operations, irrespective of group, were performed laparoscopically. The incidence of a surgical complication was 17.0 % in the ERAS group vs. 16.1 % in the conventional group (P = 0.842), in which several non-surgical complications also arose. Oral food intake was implemented earlier for the ERAS group vs. the conventional group, after a median (range) of 1 (1-31) vs. 3 (1-9) days for the ERAS vs. conventional care groups, respectively (P < 0.001). The median length of postoperative hospital stay was reduced by 5.5 days for the ERAS group, being 8.5 (5-41) vs. 14 (7-56) days for the ERAS vs. conventional care groups, respectively (P < 0.001).


CONCLUSIONS
This multi-institutional controlled study clearly demonstrated that an ERAS protocol was efficient, without increasing the complication risk.
Department of Digestive Surgery, Ikeda City Hospital, 3-1-18 Jyonan, Ikeda, Osaka, 563-8510, Japan. hirootajp@yahoo.co.jp.|Department of Surgery, Osaka Saiseikai Senri Hospital, Suita, Japan. hirootajp@yahoo.co.jp.
Hirofumi
H
Ota
Department of Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.|Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Masakazu
M
Ikenaga
Department of Surgery, Osaka Rosai Hospital, Sakai, Japan.
Junichi
J
Hasegawa
Department of Surgery, Suita Municipal Hospital, Suita, Japan.
Kohei
K
Murata
Department of Surgery, Nishinomiya Municipal Hospital, Nishinomiya, Japan.|Department of Surgery, Mino City Hospital, Mino, Japan.
Yasuhiro
Y
Miyake
Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Tsunekazu
T
Mizushima
Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Taishi
T
Hata
Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan.|Department of Surgery, Oncology and Science, Sapporo Medical University, Sapporo, Japan.
Ichiro
I
Takemasa
Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Hirofumi
H
Yamamoto
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Mitsugu
M
Sekimoto
Department of Surgery, Nishinomiya Municipal Hospital, Nishinomiya, Japan.
Riichiro
R
Nezu
Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Yuichiro
Y
Doki
Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Masaki
M
Mori
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome
Colon surgery; Enhanced recovery after surgery; Multi-institutional trial
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