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Multicenter Study
. 2025 Nov;72(9):501926.
doi: 10.1016/j.redare.2025.501926. Epub 2025 Sep 3.

Enhanced recovery after surgery and long-term oncologic outcomes: Post-hoc analysis of the POWER study

J Ripollés-Melchor  1 , A Zorrilla-Vaca  2 , A León-Bretscher  3 , A Abad-Motos  4 , P Galán-Menéndez  5 , J L Muñoz-Rodés  6 , D Zapata  2 , Á Ramiro-Ruiz  7 , C Aldecoa  8 , V Molnar  9 , L Jordá-Sanz  10 , A Cuéllar-Martínez  11 , H Berges-Gutiérrez  12 , A Landaluce-Olavarria  13 , R Fernández-García  14 , N Aracil-Escoda  15 , A M Pacual-Bellosta  16 , M Ubré-Lorenzo  17 , M Logroño-Ejea  18 , A B Serrano Romero  19 , V Soriano-Giménez  20 , J M Romero-Marcos  21 , E Nogués-Ramia  22 , A Mugarra-Llopis  23 , S Sánchez-Navas  24 , J Serrat-Puyol  25 , F J Orts-Micó  26 , M Llácer-Pérez  27 , S Gil-Trujillo  28 , E Alday-Muñoz  29 , A Calero-Lillo  30 , P Gimeno-Fernández  31 , R Sánchez-Martín  32 , D Bustos-García  33 , A Batalla-González  34 , M R Chornet  35 , R Rodríguez-Jiménez  36 , J F Anton  37 , C Jericó-Alba  37 , A Pedregosa-Sanz  38 , A Navarro-Sánchez  39 , T Viñas-Martínez  40 , J A Garcia Erce  41 , M P Oriol  15 , A Abad-Gurumeta  1
Affiliations
Multicenter Study

Enhanced recovery after surgery and long-term oncologic outcomes: Post-hoc analysis of the POWER study

J Ripollés-Melchor et al. Rev Esp Anestesiol Reanim (Engl Ed). 2025 Nov.

Abstract

Introduction/objectives: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality. While Enhanced Recovery After Surgery (ERAS) programs optimize perioperative care, their effect on oncologic prognosis requires further validation. This study evaluates ERAS adherence and five-year survival through a post-hoc analysis of the POWER Study.

Methods: This sub-analysis included 901 patients from 32 hospitals with available 5-year follow-up data. Patients undergoing elective CRC resection were stratified based on ERAS adherence (≥70%). Primary outcomes included overall survival and recurrence rates analysed using Cox proportional hazards models adjusted for clinical variables. Kaplan-Meier curves and subgroup analyses were also performed to assess stage-specific differences.

Results: No significant differences were observed in 5-year overall survival (ERAS 66% vs. non-ERAS 60%; HR: 1.14, 95% CI: 0.88-1.49; P = 0.32) or recurrence rates (ERAS 25% vs. non-ERAS 25%; HR: 0.91, 95% CI: 0.68-1.22; P = 0.53). Kaplan-Meier curves showed overlapping survival trajectories, and subgroup analyses confirmed no stage-specific disparities. While ERAS promotes early postoperative recovery and facilitates timely adjuvant therapy initiation, its effect on long-term oncologic outcomes remains inconclusive.

Conclusions: These findings support ERAS as a safe perioperative strategy that enhances short-term recovery without compromising oncologic safety. However, limitations such as the post-hoc design and incomplete long-term data warrant further research. Future studies should investigate ERAS's impact on perioperative stress, immune function, and recurrence prevention to better elucidate its role in long-term CRC outcomes.

Keywords: Colorectal cancer; Cáncer colorrectal; ERAS; Oncologic outcomes; Postoperative recovery; Recidiva; Recuperación postoperatoria; Recurrence; Resultados oncológicos; Supervivencia; Survival.

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Conflict of interest statement

Declaration of competing interest Dr Ripollés-Melchor reports personal fees from Edwards Lifesciences, Baxter and Fresenius Kabi outside the submitted work. Dr. Galán-Menéndez reports personal fees from Edwards Lifesciences outside the submitted work. Dr. Ane Abad-Motos reports personal fees from Edwards Lifesciences and Octapharma outside the submitted work. Dr. Muñoz-Rodés reports personal fees from Edwards Lifesciences outside the submitted work. Dr Afredo Abad-Gurumeta reports personal fees from Edwards Lifesciences, 3 M and MSD outside the submitted work. No other disclosures were reported.

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