A PEER-REVIEWED JOURNAL OF RESEARCH AND CLINICAL MEDICINEISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
Ru
En

Experience of Implementing Fast-Track/ERAS Protocol into Treatment Scheme for Elderly Colorectal-Cancer Patients

Study Objective: To evaluate how the implementation of an optimized fast-track/enhanced-recovery-after-surgery (ERAS) protocol influences treatment outcomes in old and senile colorectal-cancer patients.

Study Design: This was a comparative study.

Materials and Methods: The authors analyze the treatment outcomes in a group of 476 old and senile colorectal-cancer patients who underwent elective surgery. In the main (prospective) group (n = 159), the perioperative management plan included an optimized fast-track/ERAS protocol. The control (retrospective) group (n = 317) received conventional perioperative care.

Study Results: Our findings revealed statistically significant positive changes in the main group of elderly colorectal-cancer patients. These changes included reduced rates of complications, decreased opioid analgesic requirements, shorter drainage periods, and shorter stays in ICU and in hospital after surgery. In the main group, we also observed an improvement in immediate and long-term treatment outcomes and in the patients' quality of life.

Conclusion: The implementation of an optimized fast-track/ERAS protocol into treatment plans for old and senile colorectal-cancer patients shortens the treatment period and improves treatment outcomes.

G. N. Khrykov — S. M. Kirov Military Medical Academy, St. Petersburg. E-mail: ghrykov@mail.ru

N. A. Maystrenko — S. M. Kirov Military Medical Academy, St. Petersburg. E-mail: nik.m.47@mail.ru

G. M. Manikhas — I. P. Pavlov First St. Petersburg State Medical University. City Clinical Oncology Dispensary, St. Petersburg. E-mail: goronkod@zdrav.spb.ru

A. D. Khalikov — City Clinical Oncology Dispensary, St. Petersburg. E-mail: jawlan2@gmail.com

A. E. Miller — City Clinical Oncology Dispensary, St. Petersburg. E-mail: almiller@list.ru

M. H. Fridman — I. P. Pavlov First St. Petersburg State Medical University. City Clinical Oncology Dispensary, St. Petersburg. E-mail: mfridman_50@mail.ru

Доктор.ру
REFERENCES
  1. Барсуков Ю. А., Кныш В. И. Современные возможности лечения колоректального рака // Соврем. онкология. 2006. Т. 8. № 2. С. 7–16.
  2. Давыдов М. И., Аксель Е. М. Статистика злокачественных новообразований в России и странах СНГ в 2007 г. // Вестн. Рос. онкол. науч. центра им. Н. Н. Блохина РАМН. 2009. Т. 20. № 3. Прил. 1. URL: http://www.ronc.ru/attachments/article/1735/vestnik-3-2009_pril_stat_.pdf (дата обращения — 01.08.2015).
  3. Классификация злокачественных опухолей (TNM) / Под ред. Л. Х. Собина и др.; пер. с англ. и научн. ред. А. И. Щёголев, Е. А. Дубова, К. А. Павлов. М.: Логосфера, 2011. 304 с.
  4. Луфт В. М. Энтеральное клиническое питание в интенсивной медицине: фармаконутриентная характеристика и возможности дифференцированного применения // Клин. анестезиология и реаниматология. 2007. Т. 4. № 5. С. 1–15.
  5. Манихас Г. М., Хрыков Г. Н., Ханевич М. Д., Фридман М. Х. Клинические рекомендации по лечению колоректального рака у больных пожилого и старческого возраста // Успехи геронтологии. 2013. Т. 26. № 3. С. 458–468.
  6. Питание пациентов пожилого возраста // Основы клинического питания / Пер. с англ.; под ред. Л. Соботки. 2-е изд. Петрозаводск: ИнтелТек, 2003. С. 301–329.
  7. Пузин В. Н. Особенности хирургического лечения осложненных форм колоректального рака у пациентов пожилого и старческого возраста // Мед. помощь. 2006. № 6. С. 24–26.
  8. Руководство по парентеральному и энтеральному питанию / Под ред. И. Е. Хорошилова. СПб.: Нордмед-Издат, 2000. 376 с.
  9. Хрыков Г. Н., Манихас Г. М., Струков Е. Ю., Ханевич М. Д. и др. Влияние нутриционной поддержки на результаты хирургического лечения рака ободочной кишки у геронтологических больных // Вестн. хирургии им. И. И. Грекова. 2014. Т. 173. № 3. С. 77–81.
  10. Хрыков Г. Н., Струков Е. Ю., Ромащенко П. Н. Роль нутриционной поддержки в лечении больных раком толстой кишки различных возрастных групп // Вестн. Рос. воен.-мед. акад. 2013. Т. 43. № 3. С. 29–31.
  11. Хрыков Г. Н., Струков Е. Ю., Ромащенко П. Н., Миллер А. Е. Методологические аспекты предоперационной оценки больных раком толстой кишки пожилого и старческого возраста // Вестн. Рос. воен.-мед. акад. (прил.). 2014. Т. 46. № 2. С. 400.
  12. Ahmed S., Howel D., Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer // J. Geriatr. Oncol. 2014. Vol. 5. N 2. P. 133–140.
  13. Anon R. D. New classification of physical status // Anesthesiology. 1963. N 24. P. 111.
  14. Audisio R. A., Papamichael D. Treatment of colorectal cancer in older patients // Nat. Rev. Gastroenterol. Hepatol. 2012. Vol. 9. N 12. P. 716–725.
  15. Badgwell B., Stanley J., Chang G. J., Katz M. H. et al. Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilizationin cancer patients undergoing abdominal surgery // J. Surg. Oncol. 2013. Vol. 108. N 3. P. 182–186.
  16. Bagnall N. M., Malietzis G., Kennedy R. H., Athanasiou T. et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients // Colorectal. Dis. 2014. Vol. 16. N 12. P. 947–956.
  17. Bojer A. S., Roikjar O. Elderly people with colorectal cancer are oncological untreated // Eur. J. Surg. Oncol. 2015. Vol. 41. N 3. P. 421–425.
  18. Bouras G., Burns E. M., Howell A. M., Bagnall N. M. et al. Systematic review of the impact of surgical harm on quality of life after general and gastrointestinal surgery // Ann. Surg. 2014. Vol. 260. N 6. P. 975–983.
  19. Bundgaard-Nielsen M., Secher N. H., Kehlet H. “Liberal” vs. “restrictive” perioperative fluid therapy — a critical assessment of the evidence // Acta Anaestesiol. Scand. 2009. Vol. 53. N 7. P. 843–851.
  20. Cederholm T., Jagren C., Hellstrom K. Outcome of protein-energy malnutricion in elderly medical patients // Am. J. Med. 1995. Vol. 98. N 1. P. 67–74.
  21. Clavien P. A., Barkun J., de Oliveira M. L., Vauthey J. N. et al. The Clavien-Dindo classification of surgical complications: five-year experience // Ann. Surg. 2009. Vol. 250. N 2. P. 187–196.
  22. Compagna R., Aprea G., De Rosa D., Gentile M. et al. Fast track for elderly patients: Is it feasible for colorectal surgery? // Int. J. Surg. 2014. N 12. Suppl. 2. P. S20–22.
  23. Dronkers J. J., Lamberts H., Reutelingsperger I. M., Naber R. H. et al. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study // Clin. Rehabil. 2010. Vol. 24. N 7. P. 614–622.
  24. Gustafsson U. O., Scott M. J., Schwenk W., Demartines N. et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations // World J. Surg. 2013. Vol. 37. N 2. P. 259–284.
  25. Holte K., Nielsen K. G., Madsen J. L., Kehlet H. Physiologic effects of bowel preparation // Dis. Colon. Rectum. 2004. Vol. 47. N 8. P. 1397–1402.
  26. Ihedioha U., Gravante G., Lloyd G., Sangal S. et al. Curative colorectal resections in patients aged 80 years and older: clinical characteristics, morbidity, mortality and risk factors // Int. J. Colorectal. Dis. 2013. Vol. 28. N 7. P. 941–947.
  27. Jeong D. H., Hur H., Min B. S., Baik S. H. et al. Safety and feasibility of a laparoscopic colorectal cancer resection in elderly patients // Ann. Coloproctol. 2013. Vol. 29. N 1. P. 22–27.
  28. Jung B., Lannerstad O., Pahlman L., Arodell M. et al. Preoperative mechanical preparation of the colon: the patient’s experience // BMC Surg. 2007. N 7. P. 5.
  29. Keane C., Savage S., McFarlane K., Seigne R. et al. Enhanced recovery after surgery versus conventional care in colonic and rectal surgery // ANZ. J. Surg. 2012. Vol. 82. N 10. P. 697–703.
  30. Khreiss W., Huebner M., Cima R. R., Dozois E. R. et al. Improving conventional recovery with enhanced recovery in minimally invasive surgery for rectal cancer // Dis. Colon Rectum. 2014. Vol. 57. N 5. P. 557–563.
  31. Levy B. F., Scott M. J., Fawcett W. J., Day A. et al. Optimizing patient outcomes in laparoscopic surgery // Colorectal Dis. 2011. N 13. Suppl. 7. P. S8–11.
  32. Li K., Li J. P., Peng N. H., Jiang L. L. et al. Fast-track improves post-operative nutricion and outcomes of colorectal surgery: a single-center prospective trial in China // Asia Pac. J. Clin. Nutr. 2014. Vol. 23. N 1. P. 41–47.
  33. Liuu E., Canoui-Poitrine F., Tournigand C., Laurent M. et al. Accuracy of the G-8 geriatric-oncology screening tool for identifying vulnerable elderly patients with cancer according to tumour site: the ELCAPA-02 study // J. Geriatr. Oncol. 2014. Vol. 5. N 1. P. 11–19.
  34. Marventano S., Grosso G., Mistretta A., Bogusz-Czerniewicz M. et al. Evaluation of four comorbidity indices and Charlson comorbidity index adjustment for colorectal cancer patients // Int. J. Colorectal Dis. 2014. Vol. 29. N 9. P. 1159–1169.
  35. Mohri Y., Inoue Y., Tanaka K., Hiro J. et al. Prognostic nutritional index predicts postoperative outcomes in colorectal cancer // World J. Surg. 2013. Vol. 37. N 11. P. 2688–2692.
  36. Nigren J., Thacker J., Carli F., Fearon K. C. et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations // World J. Surg. 2013. Vol. 37. N 2. P. 285–305.
  37. Nitsche U., Spath C., Muller T. C., Maak M. et al. Colorectal cancer surgery remains effective with rising patient age // Int. J. Colorectal Dis. 2014. Vol. 29. N 8. P. 971–979.
  38. Ommundsen N., Wyller T. B., Nesbakken A., Jordhoy M. S. et al. Frailty is an independent predictor of survival in older patients with colorectal cancer // Oncologist. 2014. Vol. 19. N 12. P. 1268–1275.
  39. Scarpa M., Di Cristofaro L., Cortinovis M., Pinto E. et al. Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients // Surg. Endosc. 2013. Vol. 27. N 8. P. 2911–2920.
  40. Schepens T., Cammu G. Neuromuscular blockade: what was, is and will be // Acta Anaest. Belg. 2014. Vol. 65. N 4. P. 151–159.
  41. Soma T., Sugano M., Kawasaki C., Tsuji M. et al. Colorectal resection in nonagenarians: effectiveness of laparoscopic surgery // Asian. J. Endosc. Surg. 2014. Vol. 7. N 3. P. 222–226.
  42. Student. The probable error of a mean // Biometrika. 1908. Vol. 6. N 1. P. 1–25.
  43. Turrentine F. E., Wang H., Simpson V. B., Jones R. S. Surgical risk factors, morbidity, and mortality in elderly patients // J. Am. Coll. Surg. 2006. Vol. 203. N 6. P. 865–877.
  44. Ware J. E., Sherburne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection // Med. Care. 1992. Vol. 30. N 6. P. 473–483.
  45. Wildes T. M., Ruwe A. P., Fournier C., Gao F. et al. Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer // Journ. Geriatr. Oncol. 2013. Vol. 4. N 3. P. 227–234.
  46. Yang D., He W., Zhang S., Chen H. et al. Fast-track surgery improves postoperative clinical recovery and immunity after elective surgery for colorectal carcinoma: randomized controlled clinical trial // World J. Surg. 2012. Vol. 36. N 8. P. 1874–1880.
  47. Zhao J. H., Sun J. X., XGao P, Chen X. W. et al. Fast-track surgery versus traditional perioperative care in laparoscopic colorectal cancer surgery: a meta-analysis // BMC Cancer. 2014. N 14. P. 607.

Похожие статьи

News

1 October 10:52
A New Issue of Doctor.Ru Internal Medicine, Vol. 21, No. 6 (2022), Published

Find original articles and reviews covering various aspects of сardiology, gastroenterology, internal medicine and the interview with Professor Alexey Nikolaevich Kalyagin

7 July 17:16
A New Issue of Doctor.Ru Neurology Psychiatry, Vol. 21, No. 4 (2022), Published

Find original articles and reviews covering various aspects of neurology, psychiatry and the interview with Professor Alexander Vitalievich Amelin

12 May 11:25
A New Issue of Doctor.Ru Pediatrics, Vol. 21 No. 3 (2022), Published

See the original papers, reviews and clinical cases in headings Pulmonology, Rheumatology, Endocrinology, Neurology, Cross-disciplinary approach and Interview with with an Honoured Scientist of the Sakha (Yakutia) Republic Professor Maria Vasilievna Khandy

4 May 10:02
A New Issue of Doctor.Ru Internal Medicine, Vol. 21, No. 2 (2022), Published

Find original articles and reviews covering various aspects of gastroenterology, internal medicine, rheumatology, endocrinology, special section of postgraduate training and the interview with Professor Dmitry Alexeevich Sychev

18 March 00:00
A New Issue of Doctor.Ru Gynecology, Vol. 21 No. 1 (2022), Published

Find original articles and reviews covering various aspects of obstetrics, perinatology and gynecology, and the interview with Feldberg Dov, MD

All news