Future Perspectives of ERAS: A Narrative Review on the New Applications of an Established Approach

Dario Bugada, Valentina Bellini, Andrea Fanelli, Maurizio Marchesini, Christian Compagnone, Marco Baciarello, Massimo Allegri, Guido Fanelli, Dario Bugada, Valentina Bellini, Andrea Fanelli, Maurizio Marchesini, Christian Compagnone, Marco Baciarello, Massimo Allegri, Guido Fanelli

Abstract

ERAS approach (Enhanced Recovery After Surgery) is a multimodal, perioperative pathway designed to achieve early recovery after surgery. ERAS has shown documented efficacy in elective surgery, and the concept of "multimodal" and "multidisciplinary" approach seems still to be of higher importance than each single item within ERAS protocols. New perspectives include the use of ERAS in emergency surgery, where efficacy and safety on outcome have been documented, and flexibility of traditional items may add benefits for traditionally high-risk patients. Obstetric surgery, as well, may open wide horizons for future research, since extremely poor data are currently available, and ERAS benefits may translate even on the baby. Finally, the concept of "outcome" may be extended when considering the specific setting of cancer surgery, in which variables like cancer recurrence, early access to adjuvant therapies, and, finally, long-term survival are as important as the reduced perioperative complications. In this perspective, different items within ERAS protocols should be reinterpreted and eventually integrated towards "protective" techniques, to develop cancer-specific ERAS approaches keeping pace with the specific aims of oncologic surgery.

References

    1. DeBarros M., Steele S. R. Perioperative protocols in colorectal surgery. Clinics in Colon and Rectal Surgery. 2013;26(3):139–145. doi: 10.1055/s-0033-1351128.
    1. Scott M. J., Baldini G., Fearon K. C. H., et al. Enhanced Recovery after Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiologica Scandinavica. 2015;59(10):1212–1231. doi: 10.1111/aas.12601.
    1. Li P., Fang F., Cai J.-X., Tang D., Li Q.-G., Wang D.-R. Fast-track rehabilitation VS conventional care in laparoscopic colorectal resection for colorectal malignancy: a meta-analysis. World Journal of Gastroenterology. 2013;19(47):9119–9126. doi: 10.3748/wjg.v19.i47.9119.
    1. Schricker T., Lattermann R. Perioperative catabolism. Canadian Journal of Anesthesia. 2015;62(2):182–193. doi: 10.1007/s12630-014-0274-y.
    1. Cerantola Y., Valerio M., Persson B., et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced recovery after surgery (ERAS®) society recommendations. Clinical Nutrition. 2013;32(6):879–887. doi: 10.1016/j.clnu.2013.09.014.
    1. Mortensen K., Nilsson M., Slim K., et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery after Surgery (ERAS®) Society recommendations. British Journal of Surgery. 2014;101(10):1209–1229. doi: 10.1002/bjs.9582.
    1. Lassen K., Coolsen M. M. E., Slim K., et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery after Surgery (ERASⓇ) society recommendations. World Journal of Surgery. 2013;37(2):240–258. doi: 10.1007/s00268-012-1771-1.
    1. Gustafsson U. O., Scott M. J., Schwenk W., et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World Journal of Surgery. 2013;37(2):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®) society recommendations. World Journal of Surgery. 2013;37(2):285–305. doi: 10.1007/s00268-012-1787-6.
    1. Nelson G., Altman A. D., Nick A., et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery after Surgery (ERAS®) Society recommendations—part II. Gynecologic Oncology. 2016;140(2):323–332. doi: 10.1016/j.ygyno.2015.12.019.
    1. Thorell A., MacCormick A. D., Awad S., et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) society recommendations. World Journal of Surgery. 2016 doi: 10.1007/s00268-016-3492-3.
    1. Currie A., Burch J., Jenkins J. T., et al. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Annals of Surgery. 2015;261(6):1153–1159. doi: 10.1097/sla.0000000000001029.
    1. Bona S., Molteni M., Rosati R., et al. Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World Journal of Gastroenterology. 2014;20(46):17578–17587. doi: 10.3748/wjg.v20.i46.17578.
    1. Quiney N., Aggarwal G., Scott M., Dickinson M. Survival after emergency general surgery: what can we learn from enhanced recovery programmes? World Journal of Surgery. 2016;40(6):1283–1287. doi: 10.1007/s00268-016-3418-0.
    1. Bayar B., Yılmaz K. B., Akıncı M., Şahin A., Kulaçoğlu H. An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients. Turkish Journal of Surgery. 2016;32(1):11–17. doi: 10.5152/ucd.2015.2969.
    1. Roulin D., Blanc C., Muradbegovic M., Hahnloser D., Demartines N., Hübner M. Enhanced recovery pathway for urgent colectomy. World Journal of Surgery. 2014;38(8):2153–2159. doi: 10.1007/s00268-014-2518-y.
    1. Gonenc M., Dural A. C., Celik F., et al. Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial. The American Journal of Surgery. 2014;207(6):807–814. doi: 10.1016/j.amjsurg.2013.07.025.
    1. Wrench I. J., Allison A., Galimberti A., Radley S., Wilson M. J. Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience. International Journal of Obstetric Anesthesia. 2015;24(2):124–130. doi: 10.1016/j.ijoa.2015.01.003.
    1. Vogelaar F. J., Lips D. J., van Dorsten F. R., Lemmens V. E., Bosscha K. Impact of anaesthetic technique on survival in colon cancer: a review of the literature. Gastroenterology Report. 2016;4(1):30–34.
    1. Beloeil H., Nouette-Gaulain K. The perioperative period in cancer surgery: a critical moment! Is there a role for regional anesthesia in preventing cancer recurrence? Annales Francaises d'Anesthesie et de Reanimation. 2012;31(6):528–536. doi: 10.1016/j.annfar.2012.01.037.
    1. Page G. G., Blakely W. P., Ben-Eliyahu S. Evidence that postoperative pain is a mediator of the tumor-promoting effects of surgery in rats. Pain. 2001;90(1-2):191–199. doi: 10.1016/S0304-3959(00)00403-6.
    1. Gong L., Qin Q., Zhou L., et al. Effects of fentanyl anesthesia and sufentanil anesthesia on regulatory T cells frequencies. International Journal of Clinical and Experimental Pathology. 2014;7(11):7708–7716.
    1. Nguyen J., Luk K., Vang D., et al. Morphine stimulates cancer progression and mast cell activation and impairs survival in transgenic mice with breast cancer. British Journal of Anaesthesia. 2014;113(1):i4–i13. doi: 10.1093/bja/aeu090.
    1. Bimonte S., Barbieri A., Rea D., et al. Morphine promotes tumor angiogenesis and increases breast cancer progression. BioMed Research International. 2015;2015:8. doi: 10.1155/2015/161508.161508
    1. Koodie L., Yuan H., Pumper J. A., et al. Morphine inhibits migration of tumor-infiltrating leukocytes and suppresses angiogenesis associated with tumor growth in mice. American Journal of Pathology. 2014;184(4):1073–1084. doi: 10.1016/j.ajpath.2013.12.019.
    1. Willner D., Cohen-Yeshurun A., Avidan A., Ozersky V., Shohami E., Leker R. R. Short term morphine exposure in vitro alters proliferation and differentiation of neural progenitor cells and promotes apoptosis via mu receptors. PLoS ONE. 2014;9(7) doi: 10.1371/journal.pone.0103043.e103043
    1. Meserve J. R., Kaye A. D., Prabhakar A., Urman R. D. The role of analgesics in cancer propagation. Best Practice and Research: Clinical Anaesthesiology. 2014;28(2):139–151. doi: 10.1016/j.bpa.2014.04.0044.
    1. Cata J. P., Lasala J., Bugada D. Best practice in the administration of analgesia in postoncological surgery. Pain Management. 2015;5(4):273–284. doi: 10.2217/pmt.15.21.
    1. Carli F., Kehlet H., Baldini G., et al. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Regional Anesthesia and Pain Medicine. 2011;36(1):63–72. doi: 10.1097/aap.0b013e31820307f7.
    1. Rawal N. Epidural technique for postoperative pain: gold standard no more? Regional Anesthesia and Pain Medicine. 2012;37(3):310–317. doi: 10.1097/aap.0b013e31825735c6.
    1. Papadima A., Boutsikou M., Lagoudianakis E. E., et al. Lymphocyte apoptosis after major abdominal surgery is not influenced by anesthetic technique: a comparative study of general anesthesia versus combined general and epidural analgesia. Journal of Clinical Anesthesia. 2009;21(6):414–421. doi: 10.1016/j.jclinane.2008.10.015.
    1. Barr J., Boulind C., Foster J. D., et al. Impact of analgesic modality on stress response following laparoscopic colorectal surgery: a post-hoc analysis of a randomised controlled trial. Techniques in Coloproctology. 2015;19(4):231–239. doi: 10.1007/s10151-015-1270-0.
    1. Kun L., Tang L., Wang J., Yang H., Ren J. Effect of combined general/epidural anesthesia on postoperative NK cell activity and cytokine response in gastric cancer patients undergoing radical resection. Hepato-Gastroenterology. 2014;61(132):1142–1147.
    1. Cata J. P., Gottumukkala V., Sessler D. I. How regional analgesia might reduce postoperative cancer recurrence. European Journal of Pain Supplements. 2011;5(2):345–355. doi: 10.1016/j.eujps.2011.08.017.
    1. Weng M., Chen W., Hou W., Li L., Ding M., Miao C. The effect of neuraxial anesthesia on cancer recurrence and survival after cancer surgery: an updated meta-analysis. Oncotarget. 2016;7(12):15262–15273.
    1. Vogelaar F. J., Lips D. J., van Dorsten F. R., Lemmens V. E., Bosscha K. Impact of anaesthetic technique on survival in colon cancer: a review of the literature. Gastroenterology Report. 2016;4(1):30–34. doi: 10.1093/gastro/gov001.
    1. Grosu I., de Kock M. New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures. Anesthesiology Clinics. 2011;29(2):311–327. doi: 10.1016/j.anclin.2011.04.001.
    1. Li B., Liu H. Y., Guo S. H., Sun P., Gong F. M., Jia B. Q. Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer. Genetics and Molecular Research. 2015;14(2):7136–7141. doi: 10.4238/2015.june.29.7.
    1. Sane S., Hasanlui M. V., Abbasivash R., Mahoori A., Hashemi S. T., Rafiei F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Advanced Biomedical Research. 2015;4, article 230 doi: 10.4103/2277-9175.167030.
    1. De Oliveira G. S., Jr., Castro-Alves L. J. S., Ahmad S., Kendall M. C., McCarthy R. J. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesthesia & Analgesia. 2013;116(1):58–74. doi: 10.1213/ane.0b013e31826f0a0a.
    1. Assante J., Collins S., Hewer I. Infection associated with single-dose dexamethasone for prevention of postoperative nausea and vomiting: a literature review. AANA Journal. 2015;83(4):281–288.
    1. Yu H. C., Luo Y. X., Peng H., Kang L., Huang M. J., Wang J. P. Avoiding perioperative dexamethasone may improve the outcome of patients with rectal cancer. European Journal of Surgical Oncology. 2015;41(5):667–673. doi: 10.1016/j.ejso.2015.01.034.
    1. Merk B. A., Havrilesky L. J., Ehrisman J. A., Broadwater G., Habib A. S. Impact of postoperative nausea and vomiting prophylaxis with dexamethasone on the risk of recurrence of endometrial cancer. Current Medical Research and Opinion. 2016;32(3):453–458. doi: 10.1185/03007995.2015.1123146.
    1. Zhuang C.-L., Huang D.-D., Chen F.-F., et al. Laparoscopic versus open colorectal surgery within enhanced recovery after surgery programs: a systematic review and meta-analysis of randomized controlled trials. Surgical Endoscopy. 2015;29(8):2091–2100. doi: 10.1007/s00464-014-3922-y.
    1. Wang G., Jiang Z., Zhao K., et al. Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program. Journal of Gastrointestinal Surgery. 2012;16(7):1379–1388. doi: 10.1007/s11605-012-1880-z.
    1. Li P., Fang F., Cai J.-X., Tang D., Li Q.-G., Wang D.-R. Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: a meta-analysis. World Journal of Gastroenterology. 2013;19(47):9119–9126. doi: 10.3748/wjg.v19.i47.9119.
    1. Zhao J. H., Sun J. X., Huang X. Z., et al. Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery. International Journal of Colorectal Disease. 2016;31(3):613–622. doi: 10.1007/s00384-015-2493-2.
    1. Vlug M. S., Wind J., Hollmann M. W., et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study) Annals of Surgery. 2011;254(6):868–875. doi: 10.1097/sla.0b013e31821fd1ce.
    1. Okholm C., Goetze J. P., Svendsen L. B., Achiam M. P. Inflammatory response in laparoscopic vs. open surgery for gastric cancer. Scandinavian Journal of Gastroenterology. 2014;49(9):1027–1034. doi: 10.3109/00365521.2014.917698.
    1. Shu Z.-B., Cao H.-P., Li Y.-C., Sun L.-B. Influences of laparoscopic-assisted gastrectomy and open gastrectomy on serum interleukin-6 levels in patients with gastric cancer among Asian populations: a systematic review. BMC Gastroenterology. 2015;15, article 52 doi: 10.1186/s12876-015-0276-4.
    1. Li W., Zhou X., Huang Z. J., et al. Laparoscopic surgery minimizes the release of circulating tumor cells compared to open surgery for hepatocellular carcinoma. Surgical Endoscopy. 2015;29(11):3146–3153. doi: 10.1007/s00464-014-4041-5.
    1. Simpson G. S., Smith R., Sutton P., et al. The aetiology of delay to commencement of adjuvant chemotherapy following colorectal resection. International Journal of Surgical Oncology. 2014;2014:7. doi: 10.1155/2014/670212.670212
    1. Gustafsson U. O., Oppelstrup H., Thorell A., Nygren J., Ljungqvist O. Adherence to the ERAS protocol is associated with 5-year survival after colorectal cancer surgery: a retrospective cohort study. World Journal of Surgery. 2016;40(7):1741–1747. doi: 10.1007/s00268-016-3460-y.

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