Five-year oncological outcomes after enhanced recovery after surgery (ERAS) compared to conventional care for colorectal cancer: a retrospective cohort of 981 patients

Background: The enhanced recovery after surgery (ERAS) protocol has been introduced over the past three decades for patients undergoing colorectal surgery. However, the effect of this program on long-term survival is poorly studied. We evaluated the effect of ERAS on 5-year overall survival (OS) and recurrence-free survival (RFS) after colorectal cancer surgery, and identified risk factors.

Methods: This retrospective study used data from the comparison of oncological outcomes at 3 years after ERAS or conventional care (pre-ERAS), conducted in our department between 2005 and 2017, and published in 2022. A total of 981 patients were included (ERAS, n = 486; pre-ERAS, n = 495).

Results: The 5-year OS and RFS rates were similar in the ERAS and pre-ERAS groups, respectively (63.3% [58.9; 67.4] vs 57.7% [53.2; 61.9]; p = 0.055) and (69.5% [65.2; 73.4] vs 70.9% [66.6; 74.8]; p = 0.365). The 5-year OS result was confirmed by a propensity score analysis (HR 0.98 [0.71; 1.37], p = 0.911). Analysis of 5-year survival by a multivariate Cox model identified age (HR 1.28 [1.15; 1.43]), BMI < 18.5 (HR 1.62 [1.08; 2.45]), smoking (HR 1.68 [1.26; 2.24]), ASA score > 2 (HR 1.56 [1.22; 1.98]), and laparotomy interventions (HR 2.06 [1.61; 2.63]) as risk factors for death. Regarding RFS, multivariate analysis adjusted on the ERAS group identified age as a protective factor with a reduction of 10% in the risk of recurrence (HR 0.90 [0.81-0.99]). In contrast patients treated with neoadjuvant chemotherapy had a higher risk of recurrence (HR 1.41 [1.07-1.85]).

Conclusion: This study failed to demonstrate any advantage of the ERAS program in improving 5-year OS and RFS after colorectal cancer surgery. Age, undernutrition, smoking, ASA score > 2, and laparotomy interventions are independently associated with early mortality.