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HOME > Ann Coloproctol > Volume 36(4); 2020 > Article
Editorial
 Effect of the Enhanced Recovery After Surgery protocol After Colorectal Cancer Surgery
Dae Ro Limorcid
Annals of Coloproctology 2020;36(4):209-210.
DOI: https://doi.org/10.3393/ac.2020.08.16
Published online: August 31, 2020

Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Correspondence to: Dae Ro Lim, M.D. Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-6267, Fax: +82-32-621-6950 E-mail: limdaero@schmc.ac.kr

Copyright © 2020 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the article "Influence of the Enhanced Recovery After Surgery Protocol on Postoperative Inflammation and Short-term Postoperative Surgical Outcomes After Colorectal Cancer Surgery" on page 264.
See Article on Page [Related article:] 264-272
The enhanced recovery after surgery (ERAS) program is first introduced by Bardram et al. [1] in the mid-1990s, which aims to reduce surgical stress, accelerate the length of postoperative functional recovery, and reduce postoperative morbidity [2]. Since the first guidelines for colorectal surgery were published in 2005, the ERAS Society care pathways include evidence-based items designed to reduces perioperative stress, maintain postoperative physiological function, and accelerate postoperative recovery after colorectal surgery [2, 3]. The ERAS protocol usually contains 3 components; preoperative, intraoperative, and postoperative component. Each subdivided element is diverse, but if it is classified as a large item, the preoperative component includes preoperative counseling, anesthesiology consultation, and carbohydrate loading prior to surgery. The intraoperative component includes perioperative normothermia in the operation room or on arrival to the postoperative recovery unit, multimodal analgesia, prophylaxis of postoperative nausea and vomiting, and postoperative monitoring and fluid therapy. The postoperative component includes adequate postoperative fluid therapy, prevention of postoperative ileus, urinary drainage, glycaemic control, and nutritional care. This ERAS protocol is effective in reducing postoperative complications, improve recovery, and shorten the length of stay in patients after colorectal surgery [4-6]. It is reported that this ERAS protocol is effective not only in elective open colorectal surgery [7], but also in laparoscopic surgery [8], emergency surgery [9], and elderly patient surgery [10]. The ERAS protocol can be considered to reduce postoperative complication by reducing the systemic inflammatory response after colorectal surgery, but few studies have proven the relationship between the ERAS protocol and inflammatory markers (C-reactive protein, interleukin-6, neutrophil-lymphocyte ratio, and so on) [11]. A recent study reported that ERAS protocol can reduce the increase in postoperative neutrophil-lymphocyte ratio in patients with colorectal cancer [12]. However, the study on this is still lacking. Another important point in the ERAS protocol is compliance. The higher the compliance of the patients, the higher benefit will be, and the lower it is, the lower the benefit after surgery [6, 13]. There are various factors affecting ERAS compliance such as age. Therefore, ERAS needs to be improved in the future according to various factors so as to increase compliance through various studies.
A recent published study report that it demonstrated the relationship between the ERAS protocol and inflammatory marker after colorectal cancer surgery. In this well designed study reported that analysis of effect of the ERAS protocol and compliance on postoperative inflammation and short term postoperative surgical outcomes after colorectal surgery [14].

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

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  • 11. Watt DG, McSorley ST, Horgan PG, McMillan DC. Enhanced recovery after surgery: which components, if any, impact on the systemic inflammatory response following colorectal surgery?: a systematic review. Medicine (Baltimore) 2015;94:e1286.ArticlePubMedPMC
  • 12. Liu X, Wang Y, Fu Z. Impact of enhanced recovery after surgery on postoperative neutrophil-lymphocyte ratio in patients with colorectal cancer. J Int Med Res 2020;48:300060520925941. ArticlePubMedPMC
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  • 14. Jalloun HE, Lee IK, Kim MK, Sung NY, Al Turkistani SA, Park SM, et al. Influence of the enhanced recovery after surgery protocol on postoperative inflammation and short-term postoperative surgical outcomes after colorectal cancer surgery. Ann Coloproctol 2020;36:264–72.ArticlePubMedPMCPDF

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    • Impact of an ERAS based nursing program on postoperative recovery in patients undergoing grade IV day surgery: a randomized controlled trial
      Fang Liu, Han Zhang, Xiaoqing Long, Caili Li, Mingjun Huang
      BMC Nursing.2025;[Epub]     CrossRef
    • Effects of enhanced recovery after surgery nursing on patients undergoing laparoscopic colectomy: a systematic review and meta-analysis
      Dan Zhang, Miaoxiu Zhong, Liujia Jin, Lingling Chen
      BMC Gastroenterology.2025;[Epub]     CrossRef
    • Clinical study of enhanced recovery after surgery in laparoscopic appendectomy for acute appendicitis
      Zhu-Lin Li, Hua-Chong Ma, Yong Yang, Jian-Jun Chen, Zhen-Jun Wang
      World Journal of Gastrointestinal Surgery.2024; 16(3): 816.     CrossRef

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      Effect of the Enhanced Recovery After Surgery protocol After Colorectal Cancer Surgery
      Ann Coloproctol. 2020;36(4):209-210.   Published online August 31, 2020
      DOI: https://doi.org/10.3393/ac.2020.08.16
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