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Improving Conventional Recovery With Enhanced Recovery in Minimally Invasive Surgery for Rectal Cancer

Khreiss, Wael M.D.1; Huebner, Marianne Ph.D.2,3; Cima, Robert R. M.S., M.D.1; Dozois, Eric R. M.D.1; Chua, Heidi K. M.D.1; Pemberton, John H. M.D.1; Harmsen, William S. M.S.2; Larson, David W. M.B.A., M.D.1

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000101
Original Contributions: Colorectal/Anal Neoplasia
Abstract

BACKGROUND: Enhanced recovery pathways have been shown to decrease the length of hospital stay in patients undergoing colorectal surgery. Few reports have studied patients undergoing minimally invasive surgery for rectal cancer.

OBJECTIVE: Our aim was to review our experience in minimally invasive rectal cancer surgery. We report short-term outcomes and evaluate the potential advantages of the enhanced recovery protocol compared with our less intensive conventional pathway.

DESIGN: This is a consecutive retrospective study of all minimally invasive rectal cancers treated from February 2005 to December 2011. Multivariable logistic regression models were constructed to identify factors contributing to a short length of stay.

SETTINGS: This study was performed at Mayo Clinic, Rochester, Minnesota, between 2005 and 2011.

PATIENTS: A total of 346 patients were retrospectively reviewed. Seventy-eight patients were managed under the enhanced recovery pathway. Patients underwent either laparoscopic-, robotic-, or hand-assisted laparoscopic surgery for rectal cancer.

INTERVENTIONS: All patients followed either a standardized conventional pathway or an enhanced recovery pathway for perioperative care.

MAIN OUTCOME MEASURES: The primary outcome was the length of stay. Secondary outcomes were postoperative complications and 30-day readmissions.

RESULTS: Hospital stay was significantly decreased for patients who underwent minimally invasive surgery for rectal cancer and were managed with an enhanced recovery protocol, 4.1 days, vs 6.1 days for the conventional pathway (95% CI, −2.9 to −1.2 days; p < 0.0001). Rates of complications were similar between the 2 groups. Factors associated with shorter length of stay included the enhanced recovery protocol and laparoscopic or robotic surgery compared with hand-assisted laparoscopic surgery.

LIMITATIONS: This was a retrospective study at a single institution. Additional limitations include the comparison with historical controls and the potential for selection bias.

CONCLUSION: The enhanced recovery pathway is associated with a significantly decreased length of hospital stay after minimally invasive surgery for rectal cancer in this series. Decreased hospital stay was achieved without affecting short-term outcomes.

Author Information

1Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota

2Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota

3Department of Statistics and Probability, Michigan State University, East Lansing, Michigan

Funding/Support: The Department of General Surgery Research Committee funded this series.

Financial Disclosures: None reported.

Correspondence: David W. Larson, M.D., M.B.A, Department of Surgery, Division of Colorectal Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: larson.david2@mayo.edu.

© 2014 The American Society of Colon and Rectal Surgeons