• Audit and feedback
• Quality improvement
• Surgery

• Humans
• Colorectal Neoplasms/surgery
• Female
• Male
• Aged
• Enhanced Recovery After Surgery/standards
• Length of Stay/statistics & numerical data
• Italy
• Middle Aged
• Postoperative Complications/prevention & control
• Medical Audit
• Elective Surgical Procedures

• Easy-Net Project
• Italian Ministry of Health

Enhanced recovery after surgery (ERAS) program has been proved to improve postoperative outcome for many surgical procedures, including liver resection. There was limited evidence regarding the feasibility and benefit of ERAS in patients who underwent liver resection for cholangiocarcinoma.

To evaluate the feasibility of ERAS in patients who underwent liver resection for cholangiocarcinoma and its association with patient outcomes.

We retrospectively analyzed 116 cholangiocarcinoma patients who underwent hepatectomy at Srinagarind Hospital, Khon Kaen University between January 2015 and December 2016. The primary outcome was the compliance with ERAS. To determine the association between ERAS compliance and patient outcomes. the patients were categorized into those adhering more than and equal to 50% (ERAS ≥ 50), and below 50% (ERAS < 50) of all components. Details on type of surgical procedure, preoperative and postoperative care, tumor location, postoperative laboratory results, and survival time were evaluated. The compliance with ERAS was measured by the percentage of ERAS items achieved. The Kaplan-Meier curve was used for survival analysis.

The median percentage of ERAS goals achieved was 40% (± 12%). Fourteen patients (12.1%) were categorized into the ERAS ≥ 50 group, and 102 patients were in the ERAS < 50 group. Postoperative hospital stay was significantly shorter in the ERAS ≥ 50 group [8.9 d, 95% confidence interval (CI): 7.3-10.4 d] than in the ERAS < 50 group (13.7 d, 95%CI: 12.2-15.2 d) (P = 0.0217). No hepatobiliary-related complications or in-hospital mortality occurred in the ERAS ≥ 50 group. Overall survival was significantly higher in the ERAS ≥ 50 group. The median survival of the patients in the ERAS < 50 group was 1257 d (95%CI: 853.2-1660.8 d), whereas that of the patients in the ERAS ≥ 50 group was not reached.

Overall ERAS compliance for patients who underwent liver resection for cholangiocarcinoma is poor. Greater ERAS compliance could predict in-hospital, short-term, and long-term outcomes of the patients.

• Enhanced recovery program after surgery
• Cholangiocarcinoma
• Hepatectomy
• Survival
• Enhanced recovery after surgery
• Outcome

The patients undergoing laparoscopic radical colorectomy in many Chinese hospitals do not achieve high compliance with the ERAS (enhanced recovery programs after surgery) protocol.

The clinical data from 1,258 patients were collected and divided into the non-ERAS and incomplete ERAS groups.

A total of 1,169 patients were screened for inclusion. After propensity score-matched analysis (PSM), 464 pairs of well-matched patients were generated for comparative study. Incomplete ERAS reduced the incidence of postoperative complications (p = 0.002), both mild (6.7% vs. 10.8%, p = 0.008) and severe (3.2% vs. 6.0%, p = 0.008). Statistically, incomplete ERAS reduced indirect surgical complications (27,5.8% vs. 59, 12.7) but not local complications (19,4.1% vs. 19, 4.1%). The subgroup analysis of postoperative complications revealed that all patients benefited from the incomplete ERAS protocol regardless of sex (male, p = 0.037, 11.9% vs. 17.9%; female, p = 0.010, 5.9% vs. 14.8%) or whether neoadjuvant chemotherapy was administered (neoadjuvant chemotherapy, p = 0.015, 7.4% vs. 24.5%; no neoadjuvant chemotherapy, p = 0.018, 10.2% vs. 15.8%). Younger patients (<60 year, p = 0.002, 7.6% vs. 17.5%) with a low BMI (<22.84, 9.4% vs. 21.1%, p < 0.001), smaller tumor size (<4.0 cm, 8.1% vs. 18.1%, p = 0.004), no fundamental diseases (8.8% vs. 17.0%, p = 0.007), a low ASA score (1/2, 9.7% vs. 16.3%, p = 0.004), proximal colon tumors (ascending/transverse colon, 12.2% vs. 24.3%, p = 0.027), poor (6.1% vs. 23.7%, p = 0.012)/moderate (10.3% vs. 15.3%, p = 0.034) tumor differentiation and no preoperative neoadjuvant radiotherapy (10.3% vs. 16.9%, p = 0.004) received more benefit from the incomplete ERAS protocol.

The incomplete ERAS protocol decreased the incidence of postoperative complications, especially among younger patients (<60 year) with a low BMI (<22.84), smaller tumor size (<4.0 cm), no fundamental diseases, low ASA score (1/2), proximal colon tumors (ascending/transverse colon), poor/moderate differentiation and no preoperative neoadjuvant radiotherapy. ERAS should be recommended to as many patients as possible, although some will not exhibit high compliance. In the future, the core elements of ERAS need to be identified to improve the protocol.

The introduction of minimal invasive principles in colorectal surgery was a major breakthrough, resulting in multiple clinical benefits, at the cost, though, of a notably steep learning process. The development of structured nation-wide training programs led to the easier completion of the learning curve; however, these programs are not yet universally available, thus prohibiting the wider adoption of laparoscopic colorectal surgery.

To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting.

We analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting. Cumulative sum analysis and change-point analysis (CPA) were introduced.

Overall, 214 patients were included. In terms of operative time, CPA identified the 110^th case as the first turning point. A plateau was reached after the 145^th case. Subgroup analysis estimated the 58^th for colon and 52^nd case for rectum operations as the respective turning points. A learning curve pattern was confirmed for pathology outcomes, but not in the conversion to open surgery and morbidity endpoints.

The learning curves in our setting validate the comparability of the results, despite the absence of National or Surgical Society driven training programs.

• Colorectal
• Education
• Gastrointestinal
• Laparoscopy
• Outcomes

• ERAS
• Early parenteral nutrition
• Operation trauma
• Postoperative disease

• COVID-19/epidemiology
• Clinical Protocols
• Cost Savings
• Enhanced Recovery After Surgery
• Humans
• Pandemics
• Patient Care Team
• Postoperative Complications/prevention & control
• Practice Guidelines as Topic
• Quality Improvement
• SARS-CoV-2
• Societies, Medical

• MR/P021220/1 Medical Research Council

• Colon cancer
• Compliance
• Enhanced recovery after surgery
• Rectal cancer
• Survival

• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Digestive System Surgical Procedures
• Enhanced Recovery After Surgery
• Humans
• Length of Stay
• Neoplasm Staging
• Patient Compliance
• Postoperative Complications

• Compliance
• Enhanced recovery after surgery
• Pelvic reconstructive surgery
• Surgical outcomes

• Aged
• Female
• Humans
• Laparotomy
• Length of Stay
• Postoperative Complications/epidemiology
• Plastic Surgery Procedures
• Retrospective Studies

• Colon
• Compliance
• Rectum
• Surgery
• Surgical wound infection