title: Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) protocols are now well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. However, the efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified.
  
  
  METHODS
  We evaluated 122 consecutive resections for obstructive colorectal cancer performed between July 2008 and November 2012 at Tokyo Metropolitan Bokutoh Hospital. Patients with rupture or impending rupture and those who received simple colostomy were excluded. The first set of 42 patients was treated based on traditional protocols, and the latter 80 according to modified ERAS protocols. The main endpoints were length of postoperative hospital stay, postoperative short-term morbidity, rate of readmission within 30 days, and mortality. Differences in modified ERAS protocols relative to traditional care include intensive preoperative counseling (by both surgeons and anesthesiologists), perioperative fluid management (avoidance of sodium/fluid overload), shortening of postoperative fasting period and early provision of oral nutrition, intraoperative warm air body heating, enforced postoperative mobilization, stimulation of gut motility, early removal of urinary catheter, and a multidisciplinary team approach to care.
  
  
  RESULTS
  Median (interquartile range) postoperative hospital stay was 10 (10-14.25) days in the traditional group, and seven (7-8.75) days in the ERAS group, showing a 3-day reduction in hospital stay (p < 0.01). According to the Clavien-Dindo classification, overall incidences of grade 2 or higher postoperative complications for the traditional and ERAS groups were 15 and 10% (p = 0.48), and 30-day readmission rates were 0 and 1.3% (p = 1.00), respectively. As for mortality, one patient in the traditional group died and none in the ERAS group (p = 0.34).
  
  
  CONCLUSIONS
  Modified ERAS protocols for obstructive colorectal cancer reduced hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible for patients with obstructive colorectal cancer.
authors.affiliation: Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan. dshida-tky@umin.ac.jp.
authors.forename: Dai
authors.initials: D
authors.lastname: Shida
authors.affiliation: Department of Anesthesiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Tagawa
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inada
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nasu
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Seyama
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Maeshiro
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Sachio
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koto-bashi, Sumida-ku, Tokyo, 1308575, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Umekita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011300:Preoperative Care; D012189:Retrospective Studies
keywords: ERAS; Length of hospital stay; Obstructive colorectal cancer