Does high compliance with the enhanced recovery after surgery protocol improve 5-year survival? A cohort study of 468 nonmetastatic colorectal cancer patients.

Abstract

Introduction: Well‑documented immediate benefits of the enhanced recovery after surgery (ERAS) protocol 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 the ERAS protocol compliance on the long‑term outcomes after laparoscopic colorectal resection.

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

Results: The group 1 consisted of 128 patients, while the group 2 included 340 individuals. There were no significant differences between the groups in terms of sex, age, body mass index, American Society of Anesthesiologists scale, or comorbidities. The Kaplan-Meier curve and log‑rank test analyses indicated that the 2 groups of ERAS protocol adherence did not significantly differ in terms of 5‑year overall survival. In the patients with American Joint Committee on Cancer (AJCC) stage 1-2, those with ERAS compliance of 80% or higher had a significantly better 5‑year survival rate than those with compliance below 80%, indicating that greater adherence to the ERAS protocol is associated with improved survival outcomes. In the case of AJCC stage 3 patients, the ERAS compliance did not significantly alter survival rates.

Conclusion: High adherence to the ERAS protocol appeared to improve the 5‑year survival rate in the patients with AJCC stage 1-2 colorectal cancer.