Open AccessImpact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer
Author(s) -
Quiram B. J.,
Crippa J.,
Grass F.,
Lovely J. K.,
Behm K. T.,
Colibaseanu D. T.,
Merchea A.,
Kelley S. R.,
Harmsen W. S.,
Larson D. W.
Publication year - 2019
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11131
Subject(s) - medicine , hazard ratio , colorectal cancer , surgery , retrospective cohort study , invasive surgery , cancer , laparoscopy , confidence interval
Background Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer. Methods This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short‐term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care. Results A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease‐free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272). Conclusion Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease‐specific survival.