Evaluation of an enhanced recovery program for elective open colorectal cancer surgery

Background: Traditional colorectal surgeries usually require a relatively long hospital stay of around 12 days. Inadequate pain control, intestinal dysfunction, and immobilization are the main factors associated with delay in recovery. Fast track or enhanced recovery colorectal protocols have been used to optimize the perioperative care and to enhance postoperative recovery. Objectives: This study aimed to determine the outcome of an enhanced recovery program for selected patients with colorectal malignancies subjected to elective surgery. Methodology: This prospective study was carried out at Fayoum University Hospital from 2008 to 2013 and included 32 patients with colorectal cancer who had undergone elective open colorectal surgeries on the basis of the fast-track protocol. Hospital stay, perioperative morbidity, and mortality data were collected, analyzed, and recorded. All patients were followed up for 24 months. Results: The mean (±SD) age of the patients was 48.2 ± 5.3 years; 22 patients were men and 10 were women. According to the ASA score, 34.4% of the patients were 1 and 65.6% were 2; 40.6% underwent low anterior resection, 34.4% underwent sigmoidectomy, and 25% underwent right hemicolectomy. The mean (±SD) length of postoperative hospital stay was 3.56 ± 0.24 days. There was no mortality and the overall morbidity rate was 25%; 3.1% of patients developed a wound infection, 3.1% of patients developed abdominal wall dehiscence, 15.6% of patients had persistent vomiting, and one patient (3.1%) required readmission and resurgery to manage anastomotic leakage and peritonitis. Conclusion: An enhanced recovery program for elective colorectal cancer surgery has a very good impact on postoperative recovery as it shortens the length of hospital stay with high safety and good patient compliance; thus, we strongly recommend the application of such protocols, provided that there is availability of well-trained and adequately experienced personnel in equipped centers.