Introduction: The implementation of an Enhanced Recovery After Surgery (ERAS) protocol in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) has been deemed unfeasible until now because of the heterogeneity of this disease and low caseloads. Since evidence and experience with ERAS principles in colorectal cancer care are increasing, a modified ERAS protocol for this specific group has been developed. The aim of this study is to evaluate the implementation of a tailored ERAS protocol for patients with LARC or LRRC, requiring beyond total mesorectal excision (bTME) surgery. Methods: Patients who underwent a bTME for LARC or LRRC between October 2021 and December 2022 were prospectively studied. All patients were treated in accordance with the ERAS LARRC protocol, which consisted of 39 ERAS care elements specifically developed for patients with LARC and LRRC. One of the most important adaptations of this protocol was the anaesthesia procedure, which involved the use of total intravenous anaesthesia with intravenous (iv) lidocaine, iv methadone, and iv ketamine instead of epidural anaesthesia. The outcomes showed compliance with ERAS care elements, complications, length of stay, and functional recovery. A follow-up was performed at 30 and 90 days post-surgery. Results: Seventy-two patients were selected, all of whom underwent bTME for either LARC (54.2%) or LRRC (45.8%). Total compliance with the adjusted ERAS protocol was 73.6%. Major complications were present in 12 patients (16.7%), and the median length of hospital stay was 9 days (IQR 6.0–14.0). Patients who received multimodal anaesthesia (75.0%) stayed in the hospital for a median of 7.0 days (IQR 6.8–15.5). These patients received fewer opioids on the first three postoperative days than patients who received epidural analgesia (p< 0.001). Conclusions: The implementation of the ERAS LARRC protocol seemed successful according to its compliance rate of >70%. Its complication rate was substantially reduced in comparison with the literature. Multimodal anaesthesia is feasible in beyond TME surgery with promising effects on recovery after surgery.
引言：由于局部晚期直肠癌（LARC）和局部复发性直肠癌（LRRC）的疾病异质性及病例数量较少，迄今为止，针对此类患者实施加速康复外科（ERAS）方案被认为不可行。随着结直肠癌治疗中ERAS原则的证据和经验不断积累，现已针对这一特定患者群体制定了改良的ERAS方案。本研究旨在评估为需要接受全直肠系膜切除扩展手术（bTME）的LARC或LRRC患者实施个体化ERAS方案的效果。方法：对2021年10月至2022年12月期间因LARC或LRRC接受bTME手术的患者进行前瞻性研究。所有患者均按照ERAS LARRC方案进行治疗，该方案包含39项专门为LARC和LRRC患者设计的ERAS护理要素。该方案最重要的调整之一是麻醉程序，采用全静脉麻醉（包括静脉注射利多卡因、美沙酮和氯胺酮）替代硬膜外麻醉。观察指标包括ERAS护理要素的依从性、并发症发生率、住院时间及功能恢复情况。术后30天和90天进行随访。结果：共纳入72例患者，均因LARC（54.2%）或LRRC（45.8%）接受了bTME手术。调整后ERAS方案的总依从率为73.6%。12例患者（16.7%）出现主要并发症，中位住院时间为9天（四分位距6.0-14.0）。接受多模式麻醉的患者（75.0%）中位住院时间为7.0天（四分位距6.8-15.5）。与接受硬膜外镇痛的患者相比，这些患者在术后前三天使用的阿片类药物更少（p<0.001）。结论：ERAS LARRC方案的实施依从率超过70%，表明其应用较为成功。与文献报道相比，该方案的并发症发生率显著降低。多模式麻醉在bTME手术中具有可行性，并对术后恢复产生积极影响。
肿瘤(癌症)患者之家