Enhanced Recovery after Surgery in Colorectal Cancer: A Prospective 6-Month Study

Background: Enhanced Recovery After Surgery (ERAS) protocols have gained considerable momentum in colorectal surgery, with evidence-based recommendations established by learned societies worldwide. However, implementation rates and outcomes vary across different healthcare settings.

Objective: To evaluate the degree of implementation of ERAS protocol recommendations in colorectal cancer surgery at EPH Mohammed Boudiaf, Ouargla, Algeria, and assess associated clinical outcomes.

Methods: A prospective, observational, single-center study was conducted over six months (October 23, 2022 to April 23, 2023) involving patients undergoing elective colorectal cancer surgery. Data were collected across preoperative, intraoperative, and postoperative periods up to 30 days post-surgery. Primary outcome was the implementation rate of ERAS protocol items. Secondary outcomes included 30-day morbidity, mortality, and length of hospital stay.

Results: Sixteen patients were included (mean age 61 years, 62.5% female). Overall ERAS protocol implementation rate was 63.89%, with the highest compliance in the postoperative period (90.63%) and lowest in the intraoperative period (52.08%). Specific item implementation rates varied: patient information (100%), antibiotic prophylaxis (100%), antiemetic prophylaxis (100%), immunonutrition (62.5%), preoperative fasting <6 hours (12.5%), carbohydrate loading (12.5%), multimodal analgesia (0%), and laparoscopic approach (6.3%). The overall morbidity rate was 18.8%, with no mortality. Mean hospital stay was 11 days (range 7-25 days, median 12 days).

Conclusion: ERAS protocol implementation in colorectal cancer surgery is feasible in our setting with moderate overall compliance. The protocol was associated with acceptable morbidity and zero mortality. Improved multidisciplinary collaboration, staff training, and resource allocation could enhance implementation rates and potentially improve clinical outcomes.