The application of enhanced recovery after surgery and negative-pressure wound therapy in the perioperative period of elderly patients with colorectal cancer

Han-Rong Liu, Ping Yang, Song Han, Yu Zhang, Hui-Yin Zhu, Han-Rong Liu, Ping Yang, Song Han, Yu Zhang, Hui-Yin Zhu

Abstract

Objective: To Explore the perioperative application of enhanced recovery after surgery (ERAS) and negative-pressure wound therapy in the elderly patients with colorectal cancer.

Methods: A retrospective clinical data were studied in the patients with colorectal cancer in Department of General Surgery in Shanghai Fourth People,s Hospital (from March, 2017 to March, 2019), One hundred and fifty patients with undergoing radical surgery for colorectal cancer were divided into two groups: ERAS group (n = 76 cases, accepting ERAS management) and Conventional treatment(CT) group (n = 74 cases, accepting traditional treatment), Bleeding in operation, the time of postoperative anal flatus, number of wound dressing changing, time of wound healing, the length of postoperative hospital stay, readmission rate, postoperative complication, were compared between the two groups.

Results: ERAS was associated with less bleeding in operation, less Wound fat liquefaction, less wound dressing changing, less time of wound healing, less time of postoperative anal flatus compare to CT group (P < 0.05); anastomotic fistula, readmission rate is similar in two groups (P > 0.05).

Conclusion: The modified ERAS can be safely applied to the perioperative period of elderly colorectal cancer patients and promote recovery; negative-pressure wound therapy is helpful for wound healing and promoting rehabilitation.

Keywords: Colorectal cancer; Enhanced recovery after surgery; Negative-pressure wound therapy; The elderly patient.

Conflict of interest statement

This article does not have any competitive conflict of interest.

© 2021. The Author(s).

References

    1. De Rijke JM, Schouten LJ, Hillen HF, et al. Cancer in the very elderly Dutch population. Cancer. 2000;89:1121–1133. doi: 10.1002/1097-0142(20000901)89:5<1121::AID-CNCR22>;2-G.
    1. Colorectal Cancer Collaborative Colorectal Cancer Collaborative GroupSurgery for colorectal cancer in elderly patients: a systematic review. Group Lancet. 2000;356:968–974. doi: 10.1016/S0140-6736(00)02713-6.
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30. doi: 10.3322/caac.21332.
    1. Hurria A, Dale W, Mooney M, et al. Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol. 2014;32:2587–2594. doi: 10.1200/JCO.2013.55.0418.
    1. Schrag D, Gelfand SE, Bach PB, et al. Who gets adjuvant treatment for stage II and III rectal cancer? Insight from surveillance, epidemiology, and end results–Medicare. J Clin Oncol. 2001;19:3712–3718. doi: 10.1200/JCO.2001.19.17.3712.
    1. Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg. 1999;86:227–230. doi: 10.1046/j.1365-2168.1999.01023.x.
    1. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fasttrack surgery. Ann Surg. 2008;248(2):189–198. doi: 10.1097/SLA.0b013e31817f2c1a.
    1. Gouvas N, Tan E, Windsor A. Fast-track vs. standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis. 2009;24:1119–1131. doi: 10.1007/s00384-009-0703-5.
    1. Adamina M, Kehlet H, Tomlinson GA, et al. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149(6):830–840. doi: 10.1016/j.surg.2010.11.003.
    1. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) society recommendations. Clin Nutr. 2012;31(6):783–800. doi: 10.1016/j.clnu.2012.08.013.
    1. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/ pelvic surgery: enhanced Recovery After Surgery (ERAS) society recommendations. Clin Nutr. 2012;31(6):801–816. doi: 10.1016/j.clnu.2012.08.012.
    1. Bardram L, Funch-Jensen P, Jensen P, et al. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345:763–764. doi: 10.1016/S0140-6736(95)90643-6.
    1. Kehlet H, Slim K. The future of fast-track surgery. Br J Surg. 2012;99:1025–1026. doi: 10.1002/bjs.8832.
    1. ERAS Compliance Group The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an International Registry. Ann Surg. 2015;261:1153–1159. doi: 10.1097/SLA.0000000000001029.
    1. Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg. 2017;152:e171032. doi: 10.1001/jamasurg.2017.1032.
    1. Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery? A systematic review and meta-analysis of major abdominal surgery. Ann Surg. 2018;267:57–65. doi: 10.1097/SLA.0000000000002267.
    1. Zhuang CL, Ye XZ, Zhang XD, et al. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667–678. doi: 10.1097/DCR.0b013e3182812842.
    1. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37:259–284. doi: 10.1007/s00268-012-1772-0.
    1. Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003;46:851–859. doi: 10.1007/s10350-004-6672-4.
    1. Nicholson A, Lowe MC, Parker J, et al. Systematic review and metaanalysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101:172–188. doi: 10.1002/bjs.9394.
    1. Bakker N, Cakir H, Doodeman HJ, et al. Eight years of experience with enhanced recovery after surgery in patients with colon cancer: impact of measures to improve adherence. Surgery. 2015;157:1130–1136. doi: 10.1016/j.surg.2015.01.016.
    1. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144:961–969. doi: 10.1001/archsurg.2009.170.
    1. Aarts MA, Okrainec A, Glicksman A, et al. Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay. Surg Endosc. 2012;26:442–450. doi: 10.1007/s00464-011-1897-5.
    1. World Health Organization . WHO Guidelines for safe surgery 2009: safe surgery saves lives. Geneva: World Health Organization; 2009.
    1. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173:2039–2046. doi: 10.1001/jamainternmed.2013.9763.
    1. Centers for Disease Control and Prevention . Surgical site infection (SSI) event. Atlanta: Centers for Disease Control and Prevention; 2015. pp. 1–27.
    1. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38:553–562. doi: 10.1097/00000637-199706000-00001.
    1. Joseph E, Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW. A prospective, randomized trial of vacuum-assisted closure versus standard therapy of chronic nonhealing wounds. Wounds. 2000;12:60–67.
    1. Wackenfors A, Gustafsson R, Sjogren J, Algotsson L, Ingemansson R, Malmsjo M. Blood flow responses in the peristernal thoracic wall during vacuum-assisted closure therapy. Ann Thorac Surg. 2005;79:1724–1731. doi: 10.1016/j.athoracsur.2004.10.053.
    1. Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–730. doi: 10.1086/501572.
    1. Shen P, Blackham AU, Lewis S, et al. Phase II randomized trial of negative-pressure wound therapy to decrease surgical site infection in patients undergoing laparotomy for gastrointestinal, pancreatic, and peritoneal surface malignancies. J Am Coll Surg. 2017;224:726–737. doi: 10.1016/j.jamcollsurg.2016.12.028.
    1. Pappalardo G, Coiro S, De Lucia F, et al. Open phincter-preserving surgery of extraperitoneal rectal cancer without primary stoma and Fast Track Protocol[J] G Chir. 2016;37(6):257–261. doi: 10.11138/gchir/2016.37.6.257.
    1. Elhassan A, Elhassan I, Elhassan A, et al. Essential Elements for Enhanced Recovery After Intra-abdominal Surgery. Curr Pain Headache Rep. 2019;23:21. doi: 10.1007/s11916-019-0753-5.
    1. Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003;46:851–859. doi: 10.1007/s10350-004-6672-4.
    1. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) society recommendations. World J Surg. 2013;37:259–284. doi: 10.1007/s00268-012-1772-0.
    1. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS((R))) society recommendations. World J Surg. 2013;37:285–305. doi: 10.1007/s00268-012-1787-6.
    1. Sanders G, Mercer SJ, Saeb-Parsey K, et al. Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery. Br J Surg. 2001;88:1363–1365. doi: 10.1046/j.0007-1323.2001.01872.x.

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