Implementation of enhanced recovery after surgery and its increasing compliance improved 5-year overall survival in resectable stage III colorectal cancer

Abstract

Purpose: Enhanced recovery after surgery (ERAS) improves short-term outcomes after colorectal cancer (CRC) surgery, but its benefits on oncological results remain unclear. The objectives of this study are (1) to compare 5-year overall survival (OS) following non-metastatic CRC surgery between ERAS and conventional care (CC), and (2) to evaluate the association between ERAS compliance and OS. Methods: Patients undergoing curative resection for stage I–III CRC in a university hospital were reviewed. Utilizing the 2010–2012 CRC registry, 5-year OS of surgical patients between ERAS and CC were compared. Utilizing the 2010–2016 ERAS registry, 5-year OS between patients with high ERAS compliance (≥ 70%) and their counterparts were compared. Results: Between 2010 and 2012, 349 patients had curative surgery: 70 (20%) with ERAS and 279 (80%) with CC. The 5-year OS was 80.3% in ERAS and 65.6% in CC (HR 0.54, 95%CI 0.33–0.88, p = 0.014). After adjustment with other variables, ERAS was associated with better 5-year OS for stage III CRC only (72.6% vs. 57.2%, adjusted HR 0.54, 95%CI 0.30–0.98, p = 0.041). Regarding ERAS compliance, 320 patients were reviewed: 232 (73%) with high compliance. The 5-year OS was 83.9% in high compliance and 69.6% in low compliance (HR 0.49, 95% CI 0.29–0.83, p = 0.007). After adjustment with cancer staging, high compliance had better 5-year OS in stage III CRC only (80.5% vs. 60.7%, adjusted HR 0.44, 95%CI 0.23–0.84, p = 0.013). Conclusion: ERAS was associated with improved 5-year OS following non-metastatic CRC surgery (especially stage III disease) than CC. High ERAS compliance had better OS than its counterpart.