• World journal of surgery · Feb 2012

    Randomized Controlled Trial Comparative Study

    Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial.

    • Li Ren, Dexiang Zhu, Ye Wei, Xiangou Pan, Li Liang, Jianmin Xu, Yunshi Zhong, Zhanggang Xue, Ling Jin, Shaokang Zhan, Weixin Niu, Xinyu Qin, Zhaohan Wu, and Zhaoguang Wu.
    • Department of General Surgery, Zhongshan Hospital, Fudan University Medical Center, Shanghai, 200032, People's Republic of China.
    • World J Surg. 2012 Feb 1;36(2):407-14.

    BackgroundThe aim of this trial was to compare the Enhanced Recovery After Surgery (ERAS) program with conventional perioperative management in patients who underwent radical resection for colorectal cancer.MethodsA combination of evidence-based and consensus methodology was used to develop the ERAS protocol. Five hundred ninety-seven consecutive patients who underwent elective colorectal resection were randomized to either the ERAS (n = 299) or the control group (n = 298). Outcomes relating to nutrition and metabolism index, stress index, and recovery index were measured and recorded.ResultsDemographic and operative data were similar between the two groups. Patients in the ERAS group showed improved nutritional status when compared with those of the control group. On postoperative day (POD) 1, the HOMA-IR (insulin resistance index) of the ERAS group was lower than that of the control group (p < 0.001). The cortisol level of the control group was elevated on both POD 1 (p = 0.007) and POD 5 (p = 0.002) compared to the preoperative level. However, the cortisol level of the ERAS group was not increased until POD 5 (p = 0.001). Reduced levels of TNF-α, IL-1β, IL-6, and IFN-γ in the ERAS group indicated less postoperative stress responses. In addition, ERAS was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay (p < 0.001) and expense (p < 0.001) for the ERAS group were reduced in comparison to the controls. Twenty-eight cases in the control group and twenty-nine in the ERAS group suffered complications, which was not significantly different.ConclusionThe ERAS protocol attenuates the surgical stress response and accelerates postoperative recovery without compromising patient safety.

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