Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Abstract

Abstract Purpose: Our study aims to compare postoperative bowel function recovery between standard right and left sided colorectal resections and explore the need to modify ERAS protocol for right sided colonic resections.Methods: data from a prospective database of elective right colonic resections (RCR) and left colorectal resections (LCR) between January 2016 to December 2019 was analyzed. Primary outcome was to compare return of bowel function and development of post-operative ileus between RCR and the LCR groups. Secondary outcomes were length of stay, post-operative complications, 30-day re-admission, and re-operation rates.Results: Of 193 eligible patients, 72 (37.3%) were in RCR group while 171 (62.7%) were in LCR group. Laparoscopic approach was used in (41/72) 56.9% of RCR group and (90/121) 74.4% in the LCR group. Time to escalation to low residue diet was 4.29 (1-18) days in RCR vs 2.89 (1-16) days in LCR group, p=0.001. Time to flatus was 3.07 (1-12) days in RCR group and 2.44 (1-6) days in LCR group, p=0.008. 21(29.2%) patients in RCR and 16 (13.2%) in LCR groups had postoperative ileus, p=0.007. Male sex and right colonic resections were found to be significant and independent risk factors for post-operative ileus after uni- and multivariate analysis. Conclusion: Right colonic resections are associated with delayed postoperative bowel function even after high compliance with ERAS protocol. Modification of ERAS protocol elements related to postoperative feeding and addition of new interventions may help to avoid delayed bowel function recovery.