Application of the Program of Enhanced Recovery in Surgical Treatment of Patients with Colorectal Cancer Complicated by Acute Obstruction (Our Experience)

Abstract

Over the last years, the number of publications devoted to the concept of enhanced recovery after surgery (ERAS) in emergency abdominal surgery application increases. The purpose of this study was a comparative analysis of the results of the ERAS-program application in surgical treatment of the patients with colorectal cancer complicated by large bowel obstruction (LBO). The study included 89 patients with obstructive colorectal carcinoma (OCRC), divided in the ERAS and control group (n=45 and n=44, respectively). During the treatment of the patients of the ERAS group in preoperative period, the following measures were taken: patient information, his psychological preparation, prevention of postoperative pain, nausea and vomiting, thromboembolic and infectious complications. Intraoperative measures included local anaesthesia of the skin in the line of laparotomy access, colon and small (under indications) intestines decompression, small intestine lavage, embryology oriented surgery and D3 lymphadenectomy, temporary installation of polyurethane catheter distal to the ligament of Treitz for early enteral nutrition, rectus sheath catheterization to carry out rectus sheath block of the anterior branches of the spinal nerves, control drainage installation into the small pelvis. In postoperative period, the early mobilization, urinary catheter and drainage removal after the patient transfer from intensive care unit were carried out. The following criteria were used as the criteria for comparative evaluation: pain syndrome intensity, need for analgesics, time of enteric deficiency arresting, postoperative complications and mortality, postoperative period duration, and patients' life quality after discharge from the hospital. It has been established that the proposed original ERAS program for this category of the patients is safe and effective due to improving the immediate results of surgical treatment.