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Thomas M, Agarwal V, DeSouza A, Joshi R, Mali M, Panhale K, Salvi OK, Ambulkar R, Shrikhande S, Saklani A. Enhanced recovery pathway in open and minimally invasive colorectal cancer surgery: a prospective study on feasibility, compliance, and outcomes in a high-volume resource limited tertiary cancer center. Langenbecks Arch Surg 2023; 408:99. [PMID: 36811742 DOI: 10.1007/s00423-023-02832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Enhanced recovery program (ERP) has demonstrated improved postoperative outcomes with increased compliance to pathway. However, there is scarce data on feasibility and safety in resource limited setting. The objective was to assess compliance with ERP and its impact on postoperative outcomes and return to intended oncological treatment (RIOT). METHODS A single center prospective observational audit was conducted from 2014 to 2019, in elective colorectal cancer surgery. Before implementation, multi-disciplinary team was educated regarding ERP. Compliance to ERP protocol and its elements was recorded. Impact of quantum of compliance (≥80% vs. <80%) to ERP on postoperative morbidity, mortality, readmission, stay, re-exploration, functional GI recovery, surgical-specific complications, and RIOT was evaluated for open and minimal invasive surgery (MIS). RESULTS During study, 937 patients underwent elective colorectal cancer surgery. Overall compliance with ERP was 73.3%. More than 80% compliance was observed in 332 (35.4%) patients in the entire cohort. Patients with <80% compliance had significantly higher overall, minor and surgery-specific complications, longer postoperative stay, delayed functional GI recovery for both open and MIS procedures. RIOT was observed in 96.5% patients. Duration to RIOT was significantly shorter following open surgery with ≥80% compliance. Compliance <80% to ERP was identified as one of the independent predictors for developing postoperative complications. CONCLUSION The study demonstrates beneficial impact of increased compliance to ERP on postoperative outcomes following open and minimally invasive surgery for colorectal cancer. Within a resource limited setting, ERP was found to feasible, safe, and effective in both open and minimally invasive colorectal cancer surgery.
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Affiliation(s)
- Martin Thomas
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
- Department of Intensive Care Medicine, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Vandana Agarwal
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India.
| | - Ashwin DeSouza
- Department of Gastrointestinal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Riddhi Joshi
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
- Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Minal Mali
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
- King Edward Memorial Hospital, Mumbai, Maharashtra, 400012, India
| | - Karuna Panhale
- Research Nurse, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Omkar K Salvi
- Research Statistician, Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Maharashtra, 400012, India
| | - Reshma Ambulkar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Shailesh Shrikhande
- Department of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Avanish Saklani
- Department of Gastrointestinal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
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Joshi R, Thomas M, Patkar S, Gupta AM, Panhale K, Rane PP, Ambulkar R, Goel M, Shrikhande SV, Agarwal V. Impact of enhanced recovery pathway in 408 gallbladder cancer resections. HPB (Oxford) 2022; 24:47-56. [PMID: 34187721 DOI: 10.1016/j.hpb.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/16/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is the sixth most common gastrointestinal malignancy with poor prognosis. Enhanced Recovery Pathway (ERP) is associated with improved outcomes following abdominal surgical procedures. Currently, there is no study evaluating ERP in patients undergoing GBC surgery. The objective was to assess compliance with ERP elements and evaluate its impact on postoperative outcomes. METHODS Prospective study conducted from February 2014-2019, including elective GBC surgery. Team was educated prior to ERP implementation. Compliance with the protocol, functional gastrointestinal (GI) recovery, mobilisation, and postoperative outcomes were recorded. Impact of degree of compliance (more or less than 80%) with ERP and postoperative outcomes was evaluated. RESULTS In 408 patients, compliance with ERP was 84.6% (53.8-100%). Compliance >80% with ERP elements was observed in 245 patients (60%). Patients with >80% compliance had lower rate of minor (18.8% vs. 27%, p = 0.050) and significantly less major (0.8% vs. 6.1%, p = 0.002) and postoperative stay (5.84 ± 4.86 vs. 7.55 ± 6.6 days, p < 0.001) and earlier functional GI recovery. Intraoperative blood loss more than 600 ml, lower compliance (<80%) with ERP and preoperative albumin independently predicted postoperative complications. CONCLUSION This study demonstrates safety and efficacy of enhanced recovery pathway in gallbladder cancer. Higher compliance with the pathway was associated with significantly improved postoperative outcomes following gallbladder cancer surgery.
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Affiliation(s)
- Riddhi Joshi
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Martin Thomas
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Shraddha Patkar
- Department of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Amit M Gupta
- Department of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Karuna Panhale
- Research Nurse, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Pallavi P Rane
- Scientific Assistant (Statistics), Clinical Research Secretariat, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Kharghar, Navi Mumbai 410210, India
| | - Reshma Ambulkar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Mahesh Goel
- Department of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Shailesh V Shrikhande
- Department of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Vandana Agarwal
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012, India.
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