Other outcome parameters were unsuitable for meta- analysis , but seemed to favour ERAS .
Analysis shows a reduction in overall complications , but major complications were not reduced .
Length of stay was reduced significantly .
We state that ERAS seems safe , but the quality of trials and lack of sufficient other outcome parameters do not justify implementation of ERAS as the st and ard of care .
Within ERAS protocol s included , no answer regarding the role for minimally invasive surgery ( i.e. laparoscopy ) was found .
BACKGROUND In recent years the Enhanced Recovery after Surgery ( ERAS ) postoperative pathway in (ileo-)colorectal surgery , aim ing at improving perioperative care and decreasing postoperative complications , has become more common .
OBJECTIVES We investigated the effectiveness and safety of the ERAS multimodal strategy , compared to conventional care after (ileo-)colorectal surgery .
The primary research question was whether ERAS protocol s lead to less morbidity and secondary whether length of stay was reduced .
A Prospective Randomized Controlled Trial of Multimodal Perioperative Management Protocol in Patients Undergoing Elective Colorectal Resection for Cancer
Objective : A prospect i ve r and omized controlled trial ( RCT ) of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer . Aims : This study evaluates the use of a multimodal package in colorectal cancer surgery in the context of an RCT . Methods : Patients for elective resection for colorectal cancer were offered trial entry . Participants were stratified by sex and requirement for a total mesorectal excision and central ly r and omized .  Multimodal patients received intravenous fluid restriction , unrestricted oral intake with prokinetic agents , early ambulation , and fixed regimen epidural analgesia . Control patients received intravenous fluids to prevent oliguria , restricted oral intake until return of bowel motility , and weaning regimen epidural analgesia . Adherence to both regimens was reinforced using a daily checklist and protocol guidance sheets . Discharge decision was made using preagreed criteria . The primary endpoint was postoperative stay , and achievement of independence milestones . Secondary endpoints were postoperative complications , readmission rates , and mortality . Analysis was by intention to treat . Results : Seventy patients were recruited . Approximately one fourth underwent TME . Median ages were similar ( 69.3 vs. 73.0 years ) . The median stay was significantly reduced in the multimodal group ( 5 vs. 7 days ; P < 0.001 , Mann-Whitney U test ) . Patients in the control arm were 2.5 times as likely to require a postoperative stay of more than 5 days . Patients in the multimodal group had less cardiorespiratory and anastomotic complications but more readmissions . There were 2 deaths , both controls . Conclusions : This RCT provides level 1b evidence that a multimodal management protocol can significantly reduce postoperative stay following colorectal cancer surgery . Morbidity and mortality are not increased
Other outcome parameters were unsuitable for meta- analysis , but seemed to favour ERAS .
Analysis shows a reduction in overall complications , but major complications were not reduced .
Length of stay was reduced significantly .
We state that ERAS seems safe , but the quality of trials and lack of sufficient other outcome parameters do not justify implementation of ERAS as the st and ard of care .
Within ERAS protocol s included , no answer regarding the role for minimally invasive surgery ( i.e. laparoscopy ) was found .
BACKGROUND In recent years the Enhanced Recovery after Surgery ( ERAS ) postoperative pathway in (ileo-)colorectal surgery , aim ing at improving perioperative care and decreasing postoperative complications , has become more common .
OBJECTIVES We investigated the effectiveness and safety of the ERAS multimodal strategy , compared to conventional care after (ileo-)colorectal surgery .
The primary research question was whether ERAS protocol s lead to less morbidity and secondary whether length of stay was reduced .