Evaluation of an enhanced recovery program for elective open colorectal cancer surgery

2015 ◽  
Vol 34 (3) ◽  
pp. 152
Author(s):  
MohamedI Abdel-Aziz ◽  
Yasser Hatata ◽  
MagedL Bolous
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Enhanced Recovery Program ◽  
Recovery Program

scholarly journals Effect of Early Peripheral Parenteral Nutrition Support in an Enhanced Recovery Program for Colorectal Cancer Surgery: A Randomized Open Trial

2021 ◽  
Vol 10 (16) ◽  
pp. 3647
Author(s):  
Luis Sánchez-Guillén ◽  
Leticia Soriano-Irigaray ◽  
Francisco López-Rodríguez-Arias ◽  
Xavier Barber ◽  
Ana Murcia ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Parenteral Nutrition ◽  
Protective Effect ◽  
Enhanced Recovery ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Enhanced Recovery Program ◽  
Major Complications ◽  
Recovery Program

Background: Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal cancer surgery within an enhanced recovery program. Methods: Patients were randomized into two groups: peripheral parenteral nutrition (PPN) (with Peri-Olimel N4-E) versus conventional fluid therapy (FT). Ninety-day postoperative complications, laboratory parameters, length of hospital stay, and compliance with the ERAS protocol were assessed. Results: A total of 158 patients were analysed. The overall 90-day complication rate was 38.6% (61 patients), and 24 patients had major complications (Clavien–Dindo III–V) (15.2%). In the multivariate analysis, the intervention (PPN vs. FC) showed a protective effect against postoperative complications (p = 0.0031, OR = 0.2 (CI: 0.08–0.87)). Following ordinal regression, PPN and early oral tolerance showed a protective effect, being less likely to develop complications or to move from minor to major complications. In patients with low compliance to ERAS during the first postoperative day, PPN showed a protective effect, preventing 28% of morbidity. Conclusions: Perioperative peripheral parenteral nutrition (PPN) support with Peri-Olimel N4-E in colorectal cancer surgery associated with early oral intake could reduce postoperative complications.

scholarly journals Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3245
Author(s):  
Francisco López-Rodríguez-Arias ◽  
Luis Sánchez-Guillén ◽  
Cristina Lillo-García ◽  
Verónica Aranaz-Ostáriz ◽  
M José Alcaide ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Composition ◽  
High Risk ◽  
Postoperative Complications ◽  
Parenteral Nutrition ◽  
Enhanced Recovery ◽  
Low Risk ◽  
Colorectal Cancer Surgery ◽  
Enhanced Recovery Program ◽  
Recovery Program

Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes.

scholarly journals Perioperative Care in Colorectal Cancer Surgery before a Structured Implementation Program of the ERAS Protocol in a Regional Network. The Piemonte EASY-NET Project

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 72
Author(s):  
Luca Pellegrino ◽  
Eva Pagano ◽  
Marco Ettore Allaix ◽  
Mario Morino ◽  
Andrea Muratore ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Controlled Trial ◽  
Baseline Period ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
North West ◽  
Implementation Program ◽  
American Society ◽  
Eras Protocol

Background: In 2019, the Enhanced Recovery After Surgery (ERAS) protocol for colorectal cancer surgery was adopted by a minority of hospitals in Piemonte (4.3 million inhabitants, north-west Italy). The present analysis aims to compare the level of application of the ERAS protocol between hospitals already adopting it (ERAS, N = 3) with the rest of the regional hospitals (non-ERAS, N = 28) and to identify possible obstacles to its application. Methods: All patients surgically treated for a newly diagnosed colorectal cancer during September–November 2019, representing the baseline period of a randomized controlled trial with a cluster stepped-wedge design, were included. Indicators of compliance to the ERAS items were calculated overall and for groups of items (preoperative, intraoperative and postoperative) and analyzed with a multilevel linear model adjusting for patients’ characteristics, considering centers as random effects. Results: Overall, the average level of compliance to the ERAS protocol was 56% among non-ERAS centers (N = 364 patients) and 80% among ERAS ones (N = 79), with a difference of 24% (95% CI: −41.4; −7.3, p = 0.0053). For both groups of centers, the lowest level of compliance was recorded for postoperative items (42% and 66%). Sex, age, presence of comorbidities and American Society of Anesthesiologists (ASA) score were not associated with a different probability of compliance to the ERAS protocol. Conclusions: Several items of the ERAS protocol were poorly adopted in colorectal surgery units in the Piemonte region in the baseline period of the ERAS Colon-Rectum Piemonte study and in the ERAS group. No relevant obstacles to the ERAS protocol implementation were identified at patient level.

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