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 .
Surgical Stress Response and Postoperative Immune Function After Laparoscopy or Open Surgery With Fast Track or Standard Perioperative Care: A Randomized Trial
Objective : To evaluate the effect of  laparoscopic or open colectomy with fast track or st and ard perioperative care on patient 's immune status and stress response after surgery . Methods : Patients with nonmetastasized colon cancer were r and omized to laparoscopic or open colectomy with fast track or st and ard care .  Blood sample s were taken preoperatively ( baseline ) , and 1 , 2 , 24 , and 72 hours after surgery . Systemic HLA-DR expression , C-reactive protein , interleukin-6 , growth hormone , prolactin , and cortisol were analyzed . Results : Nineteen patients were r and omized for laparoscopy and fast track care ( LFT ) , 23 for laparoscopy and st and ard care ( LS ) , 17 for open surgery and fast track care ( OFT ) , and 20 for open surgery and st and ard care ( OS ) . Patient characteristics were comparable . Mean HLA-DR was 74.8 in the LFT group , 67.1 in the LS group , 52.8 in the OFT group , and 40.7 in the OS group . Repeated- measures 2-way analysis of variance ( ANOVA ) showed this can be attributed to type of surgery and not aftercare ( P = 0.002 ) . Interleukin-6 levels were highest in the OS group . Repeated- measures 2-way ANOVA showed this can be attributed to type of surgery and not aftercare ( P = 0.001 ) . C-reactive protein levels were highest in the OS group . Following repeated- measures 2-way ANOVA , this can be attributed to type of surgery and not aftercare ( P = 0.022 ) . Growth hormone was lowest in the LFT group . Following repeated- measures 2-way ANOVA , this can be attributed to type of aftercare and not to type of surgery ( P = 0.033 ) . No differences between the groups were seen regarding prolactin or cortisol . No differences in ( infectious ) complication rates were observed between the groups . Conclusions : This r and omized trial showed that immune function of HLA-DR in patients undergoing laparoscopic surgery with fast track care remains highest . This can be attributed to type of surgery and not aftercare . These results may indicate a reason for the accelerated recovery of patients treated laparoscopically within a fast track program as described in the LAparoscopy and /or FAst track multimodal management versus st and ard care ( LAFA-Trial ) ( www.trialregister.nl , protocol NTR222 )
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 .