The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .
The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer: a randomized trial
Purpose This study evaluated differences in stress response and immunological function following laparoscopic and conventional total mesorectal excision ( TME ) for rectal cancer . Methods Patients with non-metastasized rectal cancer were prospect ively r and omized to open ( n = 18 ) or laparoscopic ( n = 22 ) TME .  Blood sample s were taken preoperatively ( baseline ) , 2 , 24 , and 72 h following surgery . Systemic white blood cell and monocyte count , C-reactive protein , interleukin-6 ( IL-6 ) , interleukin-8 ( IL-8 ) , HLA-DR expression on monocytes , growth hormone , prolactin , and cortisol were measured . Results Forty patients with a median age of 66 years ( interquartile range , 60–74 years ) were included . Eighteen patients ( 45 % ) were r and omized to  open surgery and 22 patients ( 55 % ) to laparoscopic surgery . Patient demographics in terms of gender , age , BMI , ASA classification , localization of the tumor , and type of neoadjuvant therapy were comparable for both groups . Laparoscopic surgery result ed in a significantly better short-term preservation of postoperative immune function . HLA-DR expression on monocytes was significantly higher ( 64 % vs 50 % , P = 0.014 ) and IL-6 level increase was significantly lower ( 4.6 vs 10.8 , P = 0.003 ) 2 h after laparoscopic surgery . No differences between the open and laparoscopic technique were observed in postoperative white blood cell count , monocyte count , C-reactive protein , IL-8 , growth hormone , prolactin , and cortisol levels . ConclusionS hort-term postoperative immune and inflammatory functions tended to be better after laparoscopic rectal surgery . However , the differences were not consistent at all time intervals , making a definitive conclusion difficult . Better preserved inflammatory function 2 h after surgery may reflect a reduction in operative trauma when the laparoscopic technique is compared with open rectal procedures
The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .