Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer.

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Serval ID
serval:BIB_8AC7A2D8B968
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer.
Journal
The British journal of surgery
Author(s)
Quiram B.J., Crippa J., Grass F., Lovely J.K., Behm K.T., Colibaseanu D.T., Merchea A., Kelley S.R., Harmsen W.S., Larson D.W.
ISSN
1365-2168 (Electronic)
ISSN-L
0007-1323
Publication state
Published
Issued date
06/2019
Peer-reviewed
Oui
Volume
106
Number
7
Pages
922-929
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Observational Study
Publication Status: ppublish
Abstract
Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer.
This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care.
A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272).
Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.
Keywords
Adenocarcinoma/mortality, Adenocarcinoma/surgery, Adult, Aged, Aged, 80 and over, Elective Surgical Procedures/methods, Female, Follow-Up Studies, Humans, Laparoscopy, Male, Middle Aged, Perioperative Care/methods, Postoperative Complications/epidemiology, Postoperative Complications/prevention & control, Proctectomy/methods, Rectal Neoplasms/mortality, Rectal Neoplasms/surgery, Retrospective Studies, Robotic Surgical Procedures, Survival Analysis, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
29/11/2021 13:28
Last modification date
07/12/2021 7:11
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