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 Impact of Open Versus Laparoscopic Resection for Colon Cancer on C-Reactive Protein Concentrations as a Predictor of Postoperative Infective Complications
Abstract Background There is increasing evidence that C-reactive protein is a useful negative predictor of infective complications and anastomotic leak following surgery for colorectal cancer . In particular , C-reactive protein concentrations on postoperative days 3 and 4 have been proposed to be of clinical utility since they aid safe and early discharge of selected patients following colorectal surgery . However , it is not clear whether such thresholds are also applicable in laparoscopic surgery . The aim of the present study was to compare the value of daily C-reactive protein concentrations in the prediction of postoperative infective complications in patients undergoing open versus laparoscopic resection for colon cancer . Methods Patients with histologically proven colon cancer who were considered to have undergone potentially curative resection in one of two university teaching hospitals in Glasgow were included in the study ( n = 344 ) . Patient characteristics were collected in a prospect i ve surgical data base . All resections were elective cases and were performed using either open ( n = 191 ) or laparoscopic surgery ( n = 153 ) .  Daily blood sample s  to measure C-reactive protein concentrations  perioperatively were taken routinely . Patients were assessed for postoperative infective and non-infective complications . Results The majority of patients were aged 65 years or older ( 75 % ) , male ( 52 % ) , had left-sided tumors ( 54 % ) , node negative disease ( 77 % ) , and did not undergo neoadjuvant treatment ( 94 % ) . Patients undergoing open and laparoscopic resection  were similar in terms of age , sex , tumor site , TNM stage , comorbidity , and infective complications . In contrast , preoperative and postoperative days 1–3 C-reactive protein concentrations were lower following laparoscopic compared with open resection in the whole cohort ( n = 344 ; all p < 0.001 ) and in those who did not develop infective complications ( n = 251 ; all p < 0.001 ) . The median length of hospital stay was shorter in the laparoscopic resection ( p < 0.001 ) . During follow-up , 127 ( 37 % ) patients developed a postoperative complication , 93 ( 73 % ) of which were infective complications . In those who developed an infective complication , there was no significant difference in the C-reactive protein concentrations between open and laparoscopic resections on postoperative days 1–4 . C-reactive protein thresholds predictive of infective complications were the same on postoperative days 3 ( 180 mg/l ) and 4 ( 140 mg/l ) following both open and laparoscopic resection for colon cancer . Conclusions The results of the present study show that although the magnitude of the systemic inflammatory response , as evidence d by C-reactive protein , following surgery was greater in open compared with laparoscopic resection , the threshold concentrations of C-reactive protein for the development of postoperative infective complications were remarkably similar on days 3 and 4
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 .