Annals of Coloproctology

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Original Article

Malignant disease, Rectal cancer

Influence of the Enhanced Recovery After Surgery Protocol on Postoperative Inflammation and Short-term Postoperative Surgical Outcomes After Colorectal Cancer Surgery: Heba Essam Jaloun, In Kyu Lee, Min Ki Kim, Na Young Sung, Suhail Abdullah Al Turkistani, Sun Min Park, Dae Youn Won, Sang Hyun Hong, Bong-Hyeon Kye, Yoon Suk Lee, Hae Myung Jeon; Ann Coloproctol. 2020;36(4):264-272. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.03.25

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24 Web of Science
24 Citations

Purpose
Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improve postoperative surgical outcomes. The purpose of this study was to observe the effects on postoperative inflammatory markers and to explore the effects of a high degree of compliance and the use of epidural anesthesia on inflammation and surgical outcomes.
Methods
Four hundred patients underwent colorectal cancer surgery at 2 hospitals during 2 different periods, namely, from January 2006 to December 2009 and from January 2017 to July 2017. Data related to the patient’s clinicopathological features, inflammatory markers, percentage of compliance with elements of the ERAS protocol, and use of epidural anesthesia were collected from a prospectively maintained database.
Results
The complication rate and the length of hospital stay (LOS) were less in the ERAS group than in the conventional group (P = 0.005 and P ≤ 0.001, respectively). The postoperative white blood cell count and the duration required for leukocytes to normalize were reduced in patients following the ERAS protocol (P ≤ 0.001). Other inflammatory markers, such as lymphocyte count (P = 0.008), neutrophil/lymphocyte ratio (P = 0.032), and C-reactive protein level (P ≤ 0.001), were lower in the ERAS protocol group. High compliance ( ≥ 70%) was strongly associated with the complication rate and the LOS (P = 0.008 and P ≤ 0.001, respectively).
Conclusion
ERAS protocols decrease early postoperative inflammation and improves short-term postoperative recovery outcomes such as complication rate and the LOS. High compliance ( ≥ 70%) with the ERAS protocol elements accelerates the positive effects of ERAS on surgical outcomes; however, the effect on inflammation was very small.

Citations

Citations to this article as recorded by

Role and importance of quality control in improving compliance of enhanced recovery after surgery to overcome postoperative complications
In Kyeong Kim, Jung Hoon Bae, Soo Ji Park, Yoon Suk Lee, In Kyu Lee
BMC Surgery.2026;[Epub] CrossRef
Robotics versus open surgery: the impact on cytokine release and patient outcomes
Sidharth Misra, Zainab Yusufali Motiwala, Aditya Puniyani, Laaiba Shamsi, Fatima Nadeem, Danny Darlington Carbin
Journal of Robotic Surgery.2025;[Epub] CrossRef
Effect of ERAS pathway nursing on postoperative rehabilitation of patients undergoing gastrointestinal surgery: a meta-analysis
Fengying Dong, Yan Li, Wenxia Jin, Zhebing Qiu
BMC Surgery.2025;[Epub] CrossRef
Remimazolam-Based Anesthesia and Systemic Inflammatory Biomarkers in Relation to Postoperative Delirium in Elderly Patients: A Retrospective Cohort Study
Hayoung Lee, Keunyoung Kim, Cheol Lee
Medicina.2025; 61(6): 1023. CrossRef
Initial experience of pure robotic single incision TME with SST technique for middle-low rectal cancer using the da Vinci SP system
Choi Nim, Kuok Chi Ian
Intelligent Surgery.2025; 8: 70. CrossRef
Effects of early activity intervention on intestinal motility recovery in patients after colorectal cancer surgery
Xiu-Lian Zhang, Ai-Ping Lin, Tian-Sheng Lin, You-Qing Huang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Challenging issues of implementing enhanced recovery after surgery programs in South Korea
Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef
Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients
Ji-Chun Tang, Jia-Wei Ma, Jin-Jin Jian, Jie Shen, Liang-Liang Cao
World Journal of Gastrointestinal Oncology.2024; 16(2): 364. CrossRef
Dysregulation of systemic immunity in colorectal cancer and its clinical applications as biomarkers and therapeutics
Changqin Li, Jian Li
Critical Reviews in Oncology/Hematology.2024; 204: 104543. CrossRef
The role of robotic-assisted surgery in the management of rectal cancer: a systematic review and meta-analysis
Chenxiong Zhang, Hao Tan, Han Xu, Jiaming Ding
International Journal of Surgery.2024; 110(10): 6282. CrossRef
Enhancing recovery and reducing inflammation: the impact of enhanced recovery after surgery recommendations on inflammatory markers in laparoscopic surgery—a scoping review
Carlos Darcy Alves Bersot, Lucas Ferreira Gomes Pereira, Victor Gabriel Vieira Goncho, José Eduardo Guimarães Pereira, Luiz Fernando dos Reis Falcão
Frontiers in Surgery.2024;[Epub] CrossRef
Enhanced recovery pathway in open and minimally invasive colorectal cancer surgery: a prospective study on feasibility, compliance, and outcomes in a high-volume resource limited tertiary cancer center
Martin Thomas, Vandana Agarwal, Ashwin DeSouza, Riddhi Joshi, Minal Mali, Karuna Panhale, Omkar K. Salvi, Reshma Ambulkar, Shailesh Shrikhande, Avanish Saklani
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Initial experience of abdominal total mesorectal excision for rectal cancer using the da Vinci single port system
Wed Alshalawi, Chul Seung Lee, In Kyeong Kim, Yoon Suk Lee
Journal of Minimally Invasive Surgery.2023; 26(4): 208. CrossRef
Association between enrollment in an enhanced recovery program for colorectal cancer surgery and long‐term recurrence and survival
Andres Zorrilla‐Vaca, Javier Ripolles‐Melchor, Ane Abad‐Motos, Inés Rubiera Mingu, Nekane Moreno‐Jurado, Fátima Martínez‐Durán, Isabel Pérez‐Martínez, Alfredo Abad‐Gurumeta, María L. FuenMayor‐Varela, Gabriel E. Mena, Michael C. Grant
Journal of Surgical Oncology.2022; 125(8): 1269. CrossRef
Implementation and improvement of Enhanced Recovery After Surgery protocols for colorectal cancer surgery
Bo Yoon Choi, Jung Hoon Bae, Chul Seung Lee, Seung Rim Han, Yoon Suk Lee, In Kyu Lee
Annals of Surgical Treatment and Research.2022; 102(4): 223. CrossRef
Effect of Enhanced Recovery after Surgery with Integrated Traditional Chinese and Western Medicine on Postoperative Stress Response of Patients with Gastrointestinal Tumors
Haiping Zhao, Wenhui Sun, Tao Huang
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Multidisciplinary treatment strategy for early colon cancer
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Korean Medical Association.2022; 65(9): 558. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Commentary: Preoperative neutrophil to lymphocyte ratio predicts complications after esophageal resection that can be used as inclusion criteria for enhanced recovery after surgery
Cheng Shen, Qiang Pu, Guowei Che
Frontiers in Surgery.2022;[Epub] CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
A propensity score-matched analysis of advanced energy devices and conventional monopolar device for colorectal cancer surgery: comparison of clinical and oncologic outcomes
Woo Jin Song, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Annals of Surgical Treatment and Research.2022; 103(5): 290. CrossRef
Enhanced recovery after surgery: importance of compliance audits
Jung Hoon Bae
Journal of the Korean Medical Association.2021; 64(12): 820. CrossRef
Effect of the Enhanced Recovery After Surgery protocol After Colorectal Cancer Surgery
Dae Ro Lim
Annals of Coloproctology.2020; 36(4): 209. CrossRef

Editorial

Benign proctology, Inflammatory bowel disease

Benefits of Elective Laparoscopic 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Sun Min Park, Won-Kyung Kang; Ann Coloproctol. 2020;36(1):3-4. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2020.02.05

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Original Article

Benign GI diease, Functional outcomes

The Effects of Preoperative Pain Education on the Decision to Discharge Patients Following Single-Incision Laparoscopic Appendectomy: Ji Won Seo, Moon Jin Kim, Sung-Hoon Yoon, Kwang Yeol Paik, Sun Min Park, Won Kyung Kang, Dosang Lee, Chul Seung Lee; Ann Coloproctol. 2020;36(6):398-402. Published online January 24, 2020; DOI: https://doi.org/10.3393/ac.2020.01.16

6,329 View
178 Download
7 Web of Science
7 Citations

Abstract PDF Supplementary Material

Purpose
Few studies have analyzed the effects of preoperative pain education on the postoperative decision to discharge. The purpose of this study was to determine the effects of pain education and management on the decision to discharge patients after single-incision laparoscopic appendectomy (SILA).
Methods
We analyzed 135 patients who had undergone SILA for acute appendicitis between March 2017 and April 2018 in a single medical center. Of these, 72 patients (53.3%) had received preoperative pain education (group 1), and 63 (46.7%) had not (group 2). We compared perioperative outcomes and complications between the groups.
Results
Baseline characteristics of sex, age, body mass index, American Society of Anesthesiologist score, and systemic inflammation factors (neutrophil-lymphocyte ratio, C-reactive protein level) did not differ significantly between the groups. There were no postoperative complications for patients in either group. Perioperative consequences and pathologic findings were not significantly different between the groups; however, length of hospital was significantly shorter in group 1.
Conclusion
Preoperative pain education in relation to postoperative pain management influenced the decision to shorten the postoperative hospital length of stay after SILA.

Citations

Citations to this article as recorded by

Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery
Hyeon Deok Choi, Sung Uk Bae
Annals of Coloproctology.2024; 40(6): 564. CrossRef
Relationship Between Appendectomy Incidence and Computed Tomography Scans Based on Korean Nationwide Data, 2003–2017
Ki Bum Park, Jinwook Hong, Jong Youn Moon, Jaehun Jung, Ho Seok Seo
Journal of Korean Medical Science.2022;[Epub] CrossRef
Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy
Abdullah Al-Sawat, Ji Yeon Mun, Sung Hoon Yoon, Chul Seung Lee
Frontiers in Surgery.2022;[Epub] CrossRef
Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study
Won Jong Kim, Ji Yeon Mun, Hee Ju Kim, Sung-Hoon Yoon, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee, Do Sang Lee, Chul Seung Lee
International Journal of Colorectal Disease.2021; 36(1): 75. CrossRef
Clinical effect of multimodal perioperative pain management protocol for minimally invasive colorectal cancer surgery: Propensity score matching study
Chul Seung Lee, Soo Ji Park, Sang Hyun Hong, Jung-Woo Shim, Min Suk Chae, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Dosang Lee, Yoon Suk Lee, Seong Taek Oh
Asian Journal of Surgery.2021; 44(2): 471. CrossRef
Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis
Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee
Annals of Coloproctology.2021; 37(4): 232. CrossRef

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