Colorectal Cancer, Colorecatal Cancer Surgery
Conditions
Keywords
Enhanced Recovery After Surgery, ERAS, Colorectal Cancer, Colorectal Surgery, Perioperative Care, Postoperative Recovery, Length of Stay, Postoperative Complications, Postoperative Pain, Early Mobilization, Bowel Function, Nursing Care
Brief summary
This study compared an Enhanced Recovery After Surgery (ERAS) care program with conventional perioperative care in adults undergoing surgery for colorectal cancer. Participants were randomly assigned to receive either ERAS care or usual care. The ERAS program included coordinated measures before, during, and after surgery aimed at supporting faster and safer recovery. The study evaluated whether ERAS could reduce the length of hospital stay and improve postoperative recovery. Other outcomes included early mobilization, return of bowel function and oral feeding, postoperative pain, complications and adverse events, removal of urinary catheters and drains, discontinuation of intravenous therapy, and selected laboratory measures. The study was conducted at the General Anticancer Oncology Hospital of Athens "Saint Savvas" in Greece.
Detailed description
Enhanced Recovery After Surgery (ERAS) programs are multimodal, evidence-based perioperative care pathways designed to reduce the physiological stress of surgery and promote earlier functional recovery. In colorectal cancer surgery, recovery may be influenced by several factors, including postoperative pain, delayed mobilization, gastrointestinal dysfunction, prolonged intravenous therapy, and the continued use of catheters and drains. This randomized controlled study was conducted to evaluate the implementation of an ERAS pathway in adult patients undergoing surgical resection for colorectal cancer and to compare postoperative recovery with that achieved through conventional perioperative care. The ERAS pathway incorporated coordinated interventions across the perioperative period, including preoperative preparation and education, perioperative analgesic management, postoperative mobilization, nutritional recovery, and planned discontinuation of supportive devices and therapies. The study focused on clinically relevant indicators of postoperative recovery. Particular attention was given to the duration of postoperative hospitalization, return of gastrointestinal function, mobilization, postoperative pain, complications and adverse events, and the timing of withdrawal of supportive interventions. Laboratory parameters were also assessed as complementary indicators of perioperative recovery. The study was conducted in a real-world oncology hospital setting and was intended to assess whether a structured ERAS pathway could improve postoperative recovery compared with the conventional perioperative care routinely provided to patients undergoing colorectal cancer surgery.
Interventions
A multimodal perioperative care pathway applied before, during, and after colorectal cancer surgery, designed to reduce surgical stress and accelerate functional recovery.
Routine perioperative care provided at the study center to patients undergoing colorectal cancer surgery.
Sponsors
University of West Attica
Saint Savvas Anticancer Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
Masking was not feasible because the ERAS pathway involved identifiable perioperative care practices implemented by the clinical team.
Intervention model description
Participants were assigned to one of two parallel groups: an Enhanced Recovery After Surgery (ERAS) perioperative care pathway or conventional perioperative care. Outcomes were assessed during the postoperative period through hospital discharge.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older. * Diagnosis of colorectal cancer. * Scheduled to undergo surgical resection of the colorectal tumor. * Ability to understand and communicate in Greek. * Sufficient cognitive capacity to understand the study information, provide informed consent, and participate in the study procedures.
Exclusion criteria
* Current treatment for chronic pain. * Use of psychopharmacological medication as defined in the study protocol. * Acute or chronic renal disease. * Acute or chronic hepatic disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Length of Hospital Stay | From the date of surgery to hospital discharge, up to approximately 14 days | Number of calendar days from the date of surgery to the date of hospital discharge, obtained from the hospital medical record. A shorter postoperative hospital stay indicates earlier discharge after colorectal cancer surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Postoperative Mobilization | From surgery until first mobilization, assessed during the first postoperative day and thereafter if needed | Time from completion of surgery to the patient's first mobilization out of bed. Recovery time was recorded using predefined postoperative time categories: 0-6, 6-12, 12-18, 18-24, and more than 24 hours. |
| Time to Full Postoperative Mobilization | From surgery until full mobilization | Time from surgery until the patient achieved full postoperative mobilization. Time was recorded in predefined categories of 0-6, 6-12, 12-18, 18-24, and more than 24 hours. |
| Time to Return of Gastrointestinal Motility | From surgery until return of gastrointestinal motility | Time from surgery to documented return of gastrointestinal motility. Recovery time was recorded using predefined categories of 0-6, 6-12, 12-18, 18-24, and more than 24 hours. |
| Time to Postoperative Oral Feeding | From surgery until resumption of oral feeding | Time from surgery to resumption of postoperative oral feeding, recorded using predefined categories of 0-6, 6-12, 12-18, 18-24, and more than 24 hours. |
| Postoperative Pain Intensity | 0-2, 2-6, 6-12, and 12-24 hours after surgery; postoperative days 1, 2, and 3; and at hospital discharge | Postoperative pain intensity assessed using a four-category verbal rating scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = very severe pain. Pain was assessed repeatedly during the postoperative period. |
| Occurrence of Postoperative Complications and Adverse Events | From surgery until hospital discharge | Occurrence of one or more predefined postoperative complications or adverse events, including nausea, vomiting, constipation, drowsiness, sedation, fever, local inflammation, bleeding, urinary tract infection, urinary retention, ileus, and reoperation. Events were recorded individually and as a composite binary outcome indicating the occurrence of any complication or adverse event. |
| Time to Urinary Catheter Removal | From surgery until urinary catheter removal | Time from surgery to removal of the urinary catheter, recorded using predefined categories of 0-6, 6-12, 12-18, 18-24, and more than 24 hours. |
| Time to Surgical Drain Removal | From surgery until drain removal | Time from surgery to removal of postoperative surgical drains, recorded using predefined categories of 0-6, 6-12, 12-18, 18-24, and more than 24 hours. |
| Time to Discontinuation of Intravenous Therapy | From surgery until discontinuation of intravenous therapy | Time from surgery to discontinuation of postoperative intravenous therapy, recorded using predefined categories of 0-6, 6-12, 12-18, 18-24, and more than 24 hours. |
Countries
Greece
Contacts
STUDY_CHAIRMartha Kelesi, Prof
Nursing Department, University of West Attica
Outcome results
None listed