Current perioperative care in patients undergoing a beyond total mesorectal excision procedure for rectal cancer: What are the differences with the colorectal enhanced recovery after surgery protocol?

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2024-10-06 DOI:10.1111/codi.17183

Stefi Nordkamp, Stijn H. J. Ketelaers, Floor Piqeur, Harm J. Scholten, Silvie van de Calseijde, Jip L. Tolenaar, Grard A. P. Nieuwenhuijzen, Harm J. T. Rutten, Jacobus W. A. Burger, Johanne G. Bloemen

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Abstract

Aim

Patients requiring a beyond total mesorectal excision (bTME) procedure for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) will probably benefit from enhanced recovery after surgery (ERAS) protocols. However, implementation of ERAS protocols in such groups of patients is considered challenging. The aims of this study were to evaluate ERAS-related outcomes of patients with LARC or LRRC undergoing bTME and to investigate the possibility of designing a tailored ERAS protocol.

Method

This study was divided into four phases. Phase one consisted of a literature study to compare functional recovery and postoperative outcomes in patients undergoing bTME. In phase two, outcomes on ERAS care elements in bTME were retrospectively evaluated. In phase three, differences in ERAS-related outcomes and compliance of the colorectal ERAS protocol in patients who had undergone bTME were studied. In phase four, multidisciplinary team meetings were held to develop an ERAS protocol for bTME patients.

Results

Seven studies reported on ERAS-related outcomes in patients undergoing bTME. Median length of hospital stay was 9–19 days, median stay in the intensive care unit was 2–4 days and 30-day postoperative major complication rates were 22.6%–61.3%. Seventy-five bTME patients were included for retrospective analysis. In these patients, length of stay was 9.0 days and major postoperative complications were observed in 40.0%. The overall ERAS compliance was 44.4%. Compared with the colorectal ERAS protocol, the largest differences in management were observed in the use of epidural anaesthesia, the postoperative use of urethral catheters, oral intake and mobilization.

Conclusion

Patients undergoing bTME for LARC or LRRC are substantially different from patients treated with the colorectal ERAS protocol, regarding ERAS-related outcomes. A tailored, multimodal ERAS protocol with specific modifications was developed by an expert multidisciplinary team for patients undergoing bTME for LARC or LRRC.

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目前对接受全直肠系膜外切除术治疗直肠癌患者的围手术期护理：与结直肠强化术后恢复方案有何不同？

目的：因局部晚期直肠癌（LARC）和局部复发性直肠癌（LRRC）而需要进行全直肠系膜切除术（bTME）以外手术的患者很可能会受益于术后恢复强化方案（ERAS）。然而，在这类患者中实施ERAS方案被认为具有挑战性。本研究的目的是评估接受 bTME 的 LARC 或 LRRC 患者的 ERAS 相关结果，并探讨设计量身定制的 ERAS 方案的可能性：本研究分为四个阶段。第一阶段包括文献研究，比较接受 bTME 患者的功能恢复和术后效果。第二阶段，对 bTME 中 ERAS 护理要素的结果进行回顾性评估。第三阶段，研究了接受过 bTME 的患者在 ERAS 相关结果和结直肠 ERAS 方案依从性方面的差异。第四阶段，召开多学科团队会议，为 bTME 患者制定 ERAS 方案：结果：七项研究报告了接受 bTME 患者的 ERAS 相关结果。住院时间中位数为9-19天，重症监护室住院时间中位数为2-4天，术后30天主要并发症发生率为22.6%-61.3%。75 例 bTME 患者被纳入回顾性分析。这些患者的住院时间为 9.0 天，术后主要并发症发生率为 40.0%。总体ERAS依从性为44.4%。与结直肠ERAS方案相比，在硬膜外麻醉的使用、术后尿道导管的使用、口服摄入和移动方面观察到了最大的管理差异：结论：在 ERAS 相关结果方面，因 LARC 或 LRRC 而接受 bTME 治疗的患者与接受结直肠 ERAS 方案治疗的患者有很大不同。一个多学科专家团队为因 LARC 或 LRRC 而接受 bTME 治疗的患者制定了一套量身定制的多模式 ERAS 方案，并对其进行了具体修改。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.