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. 2024 Jan 18;24(1):102.
doi: 10.1186/s12885-023-11803-4.

Accelerated enhanced recovery after colon cancer surgery with discharge within one day after surgery: a systematic review

Misha A T Sier  1   2 , Anke H C Gielen  3   4 , Thaís T T Tweed  3 , Noémi C van Nie  5 , Tim Lubbers  3   6 , Jan H M B Stoot  5
Affiliations

Accelerated enhanced recovery after colon cancer surgery with discharge within one day after surgery: a systematic review

Misha A T Sier et al. BMC Cancer. .

Abstract

Background: Recent studies have demonstrated that accelerated enhanced recovery after colorectal surgery is feasible for specific patient populations. The accelerated enhanced recovery protocols (ERP) tend to vary, and the majority of studies included a small study population. This hampers defining the optimal protocol and establishing the potential benefits. This systematic review aimed to determine the effect of accelerated ERPs with intended discharge within one day after surgery.

Methods: PubMed (MEDLINE), Embase, Cochrane and Web of Science databases were searched using the following search terms: colon cancer, colon surgery, accelerated recovery, fast track recovery, enhanced recovery after surgery. Clinical trials published between January 2005 - February 2023, written in English or Dutch comparing accelerated ERPs to Enhanced Recovery After Surgery (ERAS) care for adult patients undergoing elective laparoscopic or robotic surgery for colon cancer were eligible for inclusion.

Results: Thirteen studies, including one RCT were included. Accelerated ERPs after colorectal surgery was possible as LOS was shorter; 14 h to 3.4 days, and complication rate varied from 0-35.7% and readmission rate was 0-17% in the accelerated ERP groups. Risk of bias was serious or critical in most of the included studies.

Conclusions: Accelerated ERPs may not yet be considered the new standard of care as the current data is heterogenous, and data on important outcome measures is scarce. Nonetheless, the decreased LOS suggests that accelerated recovery is possible for selected patients. In addition, the complication and readmission rates were comparable to ERAS care, suggesting that accelerated recovery could be safe.

Keywords: Accelerated recovery; Colorectal surgery; Enhanced recovery after surgery; Laparoscopic surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the literature search and selection procedure
Fig. 2
Fig. 2
ROBINS-I plot risk of bias
Fig. 3
Fig. 3
ROBINS-I weighted summary plot
Fig. 4
Fig. 4
ROBINS-II plot risk of bias
Fig. 5
Fig. 5
Cochrane RoB2 graph: Review authors' judgements about each risk of bias item presented as percentages across included randomized study
See this image and copyright information in PMC

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