• Wael Khreiss, Marianne Huebner, Robert R Cima, Eric R Dozois, Heidi K Chua, John H Pemberton, William S Harmsen, and David W Larson.
• 1Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 2Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 3Department of Statistics and Probability, Michigan State University, East Lansing, Michigan.
• Dis. Colon Rectum. 2014 May 1;57(5):557-63.

BackgroundEnhanced recovery pathways have been shown to decrease the length of hospital stay in patients undergoing colorectal surgery. Few reports have studied patients undergoing minimally invasive surgery for rectal cancer.ObjectiveOur aim was to review our experience in minimally invasive rectal cancer surgery. We report short-term outcomes and evaluate the potential advantages of the enhanced recovery protocol compared with our less intensive conventional pathway.DesignThis is a consecutive retrospective study of all minimally invasive rectal cancers treated from February 2005 to December 2011. Multivariable logistic regression models were constructed to identify factors contributing to a short length of stay.SettingsThis study was performed at Mayo Clinic, Rochester, Minnesota, between 2005 and 2011.PatientsA total of 346 patients were retrospectively reviewed. Seventy-eight patients were managed under the enhanced recovery pathway. Patients underwent either laparoscopic-, robotic-, or hand-assisted laparoscopic surgery for rectal cancer.InterventionsAll patients followed either a standardized conventional pathway or an enhanced recovery pathway for perioperative care.Main Outcome MeasuresThe primary outcome was the length of stay. Secondary outcomes were postoperative complications and 30-day readmissions.ResultsHospital stay was significantly decreased for patients who underwent minimally invasive surgery for rectal cancer and were managed with an enhanced recovery protocol, 4.1 days, vs 6.1 days for the conventional pathway (95% CI, -2.9 to -1.2 days; p < 0.0001). Rates of complications were similar between the 2 groups. Factors associated with shorter length of stay included the enhanced recovery protocol and laparoscopic or robotic surgery compared with hand-assisted laparoscopic surgery.LimitationsThis was a retrospective study at a single institution. Additional limitations include the comparison with historical controls and the potential for selection bias.ConclusionThe enhanced recovery pathway is associated with a significantly decreased length of hospital stay after minimally invasive surgery for rectal cancer in this series. Decreased hospital stay was achieved without affecting short-term outcomes.

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