Has high compliance with enhanced recovery after surgery protocol improved 5-year survival? A cohort study of 468 non-metastatic colorectal cancer patients.

Abstract

Introduction: The well-documented immediate benefits of Enhanced Recovery After Surgery (ERAS) highlight the need to explore its long-term impact, particularly on survival outcomes in colorectal cancer.

Objectives: The aim of this study was to analyze the impact of ERAS protocol compliance on the long-term outcomes after laparoscopic colorectal resection.

Patients methods: Data from 468 patients who underwent laparoscopic colorectal resection between 2013 and 2017 were prospectively collected. Patients were divided into two groups based on their adherence to the ERAS protocol: group 1 with a compliance rate <80% and group 2 with a compliance rate of ≥80%. The association between ERAS protocol compliance and a 5-year survival was assessed with use of Kaplan-Meier method with log-rank tests. Additionally, survival analysis was done separately for groups depending on cancer stages.

Results: Group 1 consisted of 128 patients, while Group 2 included 340 patients. There were no statistically significant differences between the groups in terms of sex, age, BMI, ASA scale or comorbidities.  The Kaplan-Meier curve and log-rank test analyses indicated that the two groups of ERAS protocol adherence did not significantly differ in terms of a 5-year overall survival. In patients with AJCC stage 1-2 cancer, those with ERAS compliance of ≥80% had a significantly higher 5-year survival rate than those with compliance <80%, indicating that greater adherence to the ERAS protocol is associated with improved survival outcomes. In case of AJCC cancer stage 3 patients, the ERAS compliance did not significantly alter survival rates.

Conclusion: High adherence to the ERAS protocol appeared to improve a 5-year survival rate in patients with AJCC stage I-II of colorectal cancer.