EP2016 - Toward an Individualized ERAS Pathway: Key Perioperative Factors Associated with Outcomes in Colorectal Cancer Surgery

ePoster Presenter(s)

• 

  Giancarlo Sticca, MD

  General Surgery Resident
  University of Montreal
  University of Montreal
  montreal, QC, Canada

  Disclosure information not submitted.

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Author(s)

• MP

  Mihai Alexandru Popovici, n/a

  Medical Student
  Université de Montréal
  Terrebonne, Quebec, Canada

  Disclosure information not submitted.
• MH

  Margaret Henri, MD FRSCS FACS

  Clinical associate professor of surgery
  Maisonneuve-Rosemont Hospital, University of Montreal
  montreal, Quebec, Canada

  Disclosure information not submitted.
• MA

  Maria Abou-Khalil, MD PhD

  Assistant Professor
  University of Montreal
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• JT

  Jean-François Tremblay, MD

  Clinical assistant professor of surgery
  University of Montreal
  montreal, Quebec, Canada

  Disclosure information not submitted.
• YB

  Yves Bendavid, n/a

  Associate professor of surgery
  University of Montreal
  Boucherville, Quebec, Canada

  Disclosure information not submitted.
• AL

  Ariane Lacaille-Ranger, MD MEd FRCSC

  Colorectal surgeon, Assistant clinical professor
  University of Montreal
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• MP

  Madeleine Poirier, MD

  Clinical associate professor of surgery
  Maisonneuve-Rosemont Hospital
  montreal, Quebec, Canada

  Disclosure information not submitted.

Senior Author(s)

• JT

  Jean-Sébastien Trépanier, n/a

  Professeur adjoint de clinique
  Université de Montréal
  Montreal, Quebec, Canada

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Purpose/Background: Enhanced Recovery After Surgery (ERAS) pathways improve perioperative outcomes in colorectal surgery but are typically applied as bundled protocols, making it difficult to identify the impact of the individual elements driving clinical benefit. This is especially important when resources are limited or patient adherence is incomplete. This study sought to identify the impact of individual ERAS elements on postoperative (PO) outcomes following colorectal cancer resections with anastomoses.

Methods/Interventions: A prospectively maintained ERAS database (2022-2024) at a tertiary-center was analyzed. All patients undergoing elective colorectal cancer resections and anastomoses were included. Postoperative complications included ileus, anastomotic leak, infection (abdominal abscess, urinary infection, would infection), reoperation, emergency room visit and readmission. Univariate and multivariate logistic regression adjusting for outcome confounders was used to evaluate the impact of individual ERAS elements. Results are expressed as mean, medians, rations, odds ratios (OR), confidence intervals (CI) and p-values, with p< 0.05 considered significant.

Results/Outcomes: Among 298 patients, 55% were men; mean age 69.6 ± 12.8 years; BMI 27.0 ± 6.2; 10% smokers; 34% diabetic; median ASA 2. Ileus occurred in 19.4% and anastomotic leak in 3.0%. Diabetes and smoking were not associated with complications (33.6% vs 42.3%, p=0.238; 53.6% vs 40.7%, p=0.706). Delayed ambulation was associated with ileus (PO1 vs PO0: OR 2.44, p=0.037; PO2 vs PO0: OR 9.18, p< 0.001), remaining significant on multivariate analysis (PO1 vs PO0: OR 3.47, p=0.038; PO2 vs PO0: OR 35.94, p< 0.001). Preoperative oral antibiotics shortened ileus duration (3.11d vs 5.71d, p=0.04). Delayed oral intake associated with anastomotic leak on univariate analysis (OR 7.06, p=0.024) but not on multivariate analysis (OR 2.22, p=0.384). Delayed mobilization was associated to anastomotic leak on multivariate analysis (PO2 vs PO0: OR 19.2 p=0.035). In patients who had delayed oral intake postoperatively, absence of diverting ileostomy was associated with ileus (OR 19.31, p< 0.001). The absence of preoperative intravenous iron was associated with an increased odds of ileus (OR 2.77, p=0.092). All other ERAS components demonstrated no measurable impact on postoperative complications.

Conclusion/Discussion: When full ERAS compliance is not feasible, prioritizing preoperative oral antibiotics, early mobilization, early feeding and selective temporary diverting ileostomy may provide meaningful benefit. These findings support the development of pragmatic and individualized ERAS strategies for select patients undergoing colorectal cancer surgery.

Table: ERAS protocol elements for patients undergoing colorectal cancer surgery
Figure: Multivariate logistic regression for postoperative ileus and anastomotic leak