Application Of Enhanced Recovery Programme After Surgery (ERAS) In Colorectal Cancer Surgery

Objective:To evaluate whether enhanced recovery programme after surgery (ERAS) enhance recovery and decrease perioperative stress in colorectal cancer surgery,compared with traditional programme.Method:Between Sep 2006 and Mar 2008,two hundred consecutive patients, that underwent colorectal cancer surgery in colorectal professional group of Zhongshan Hospital,were randomly assigned to ERAS group and control group.Outcome measurements included programme index:volume of infusion perioperatively,time of the first out-of-bed activity,duration of being out of bed and mobiling after surgery;nutrition and metabolism index: level of hemoglobin,albumin,prealbumin,transferrin,triglyceride and nitrogen balance perioperatively;immune status:level of C3,C4,CH50, IgG,IgA,IgM and IgE perioperatively;stress index:level of blood glucose,insulin,HOMA-IR index,CRP,cortisol,IL-1β,IL-6,γ-IFN, TNF-α,IGF-BP3 perioperatively;recovery index:time of the first exhaust and defecation,time of the first fluidity intake,length of stay after surgery,expense and the incidence of postoperative complications. Results:Therewere 100 cases in ERAS group and 100 cases in the control group.Demographic and operative data were similar between two groups. The volume of infusion of ERAS group was significantly less than control group perioperatively.The time of the first out-of-bed activity of ERAS group was significantly earlier than control group after surgery.The duration of being out of bed and mobiling of ERAS group were significantly more than control group after surgery.Albumin(p=0.003) and prealbumin (p=0.020) level of ERAS group were higher than that of control group on the 1^st day after surgery and transferring level of ERAS group was higher than that of control group on the 5^th day after surgery(p=0.028) Triglyceride level of ERAS group was lower than that of control group on the 5^th day after surgery(p=0.001).Nitrogen balance of ERAS group was more than that of control group on the surgery day(p=0.003) and the 5^th day after surgery(p＜0.001),but less on the 1^st day after surgery(p＜0.001). C3 level of ERAS group was higher than that of control group on the 5^th day after surgery(p＜0.001) and IgM level of ERAS group was lower than that of control group on the 5^th day after surgery(p=0.045).There was no significant difference in HOMA-IR level between two groups perioperatively(p＞0.05).There was no significant difference in CRP level between two groups perioperatively.Cortisol level on the 1^st day (p=0.007) and the 5^th day after surgery(p=0.002) was higher than that before surgery in control group,and cortisol level on the 5^th day after surgery was higher than that before surgery in ERAS group(p=0.001).IL-1βlevel on surgery day was higher than that before surgery(p=0.030), and IL-1βlevel on the 1^st day after surgery was lower than that before surgery(p=0.002) in control group.IL-6 level on surgery day(p＜0.001), the 1^stday(p＜0.001) and the 5^th day after surgery(p=0.002) were higher than that before surgery in control group and IL-6 level on surgery day (p＜0.001),the 1^st day(p=0.009) and the 5^th day after surgery(p=0.031) were higher than that before surgery in ERAS group.TNF-αlevel of ERAS group was lower than control group on surgery day(p=0.040) and the 1^st day after surgery(p=0.018).γ-IFN level on the 5^th day after surgery was higher than that before surgery(p=0.028) in control group andγ-IFN level on the 1^st day after surgery was lower than that before surgery (p=0.001) inERAS group.There were no significant difference in IGF-BP3 level perioperatively in both of two groups.The time of the first exhaust (49.78h VS 64.53h,p＜0.001) and defecation(69.75h VS 87.51h,p＜0.001), the time of the first fluidity intake(3.41d VS 4.26d,p=0.030),length of stay after surgery(5.64d VS 6.09d,p＜0.001) and expense(15056.73yuan VS 16920.84yuan,p=0.001) of ERAS group were better than that of control group.There were 13 cases suffering from complications in control group and 11 in ERAS group,with no significant difference.Conclusion:ERAS is a safe protocol,which can enhance the body and gastrointestinal function recovery,decrease surgical stress and reduce the cost of hospitalization,with no increased incidence of complications.