Enhanced Recovery Pathway in Open and Minimally Invasive Colorectal Cancer Surgery: A Prospective study on Feasibility, Compliance and Outcomes

Abstract

Abstract Background Enhanced recovery program (ERP) has demonstrated improved postoperative outcomes with increased adherence to pathway. However, there is scarce data on feasibility and safety in resource limited setting. The objective was to assess compliance with ERP and its impact on postoperative outcomes and return to intended oncological treatment (RIOT). Methods A single center prospective observational audit was conducted from 2014–2019, in elective colorectal cancer surgery. Before implementation, multi-disciplinary team was educated regarding ERP. Adherence to ERP protocol and its elements was recorded. Impact of quantum of adherence (≥ 80% vs. <80%) to ERP on postoperative morbidity, mortality, readmission, stay, re-exploration, functional GI recovery, surgical-specific complications, and RIOT was evaluated for open and minimal invasive surgery (MIS). Results During study, 937 patients underwent elective colorectal cancer surgery. Overall Compliance with ERP was 73.3%. More than 80% compliance was observed in 332 (35.4%) patients in the entire cohort. Patients with < 80% compliance had significantly higher overall, minor and surgery-specific complications, longer postoperative stay, delayed functional GI recovery for both Open and MIS procedures. RIOT was observed in 96.5% patients. Duration to RIOT significantly was shorter following Open surgery with ≥ 80% compliance. Poor adherence to ERP was identified as one of the independent predictors for developing postoperative complications. Conclusion The study demonstrates beneficial impact on postoperative outcomes with increased adherence to ERP following open and minimally invasive surgery for colorectal cancer. Within a resource limited setting, ERP was found to feasible, safe, and effective in both open and minimally invasive colorectal cancer surgery.