Annals of Surgery Open (Mar 2023)

Patient-Reported Outcomes and Return to Intended Oncologic Therapy After Colorectal Enhanced Recovery Pathway

  • The Italian ColoRectal Anastomotic Leakage (iCral3) study group,
  • Marco Catarci, MD, FACS,
  • Giacomo Ruffo, MD,
  • Massimo Giuseppe Viola, MD,
  • Ferdinando Ficari, MD,
  • Paolo Delrio, MD,
  • Felice Pirozzi, MD,
  • Felice Borghi, MD,
  • Raffaele De Luca, MD,
  • Alberto Patriti, MD,
  • Gianluca Garulli, MD,
  • Walter Siquini, MD,
  • Stefano D’Ugo, MD, PhD, FEBS, FACS,
  • Stefano Scabini, MD,
  • Marco Caricato, MD, FACS,
  • Giusto Pignata, MD,
  • Andrea Liverani, MD,
  • Roberto Campagnacci, MD,
  • Pierluigi Marini, MD,
  • Ugo Elmore, MD,
  • Francesco Corcione, MD,
  • Roberto Santoro, MD,
  • Massimo Carlini, MD, FACS,
  • Antonio Giuliani, MD,
  • Mario Sorrentino, MD,
  • Giovanni Ferrari, MD,
  • Gianandrea Baldazzi, MD,
  • Alberto Di Leo, MD,
  • Augusto Verzelli, MD,
  • Giuseppe Sica, MD,
  • Stefano Rausei, MD,
  • Davide Cavaliere, MD,
  • Gian Luca Baiocchi, MD, FACS,
  • Marco Milone, MD,
  • Giovanni Ciaccio, MD,
  • Giovanni Domenico Tebala, MD, FACS, FRCS,
  • Marco Scatizzi, MD,
  • Luigi Boni, MD, FACS,
  • Stefano Mancini, MD,
  • Mario Guerrieri, MD,
  • Roberto Persiani, MD,
  • Andrea Lucchi, MD, FACS,
  • Dario Parini, MD,
  • Antonino Spinelli, MD,
  • Michele Genna, MD,
  • Vincenzo Bottino, MD,
  • Andrea Coratti, MD,
  • Dario Scala, MD,
  • Andrea Muratore, MD,
  • Maurizio Pavanello, MD,
  • Umberto Rivolta, MD,
  • Micaela Piccoli, MD, FACS,
  • Carlo Talarico, MD,
  • Alessandro Carrara, MD,
  • Stefano Guadagni, MD,
  • Mauro Totis, MD,
  • Franco Roviello, MD,
  • Alessandro Anastasi, MD,
  • Gianluca Guercioni, MD,
  • Giuseppe Maria Ettorre, MD,
  • Mauro Montuori, MD,
  • Pierpaolo Mariani, MD,
  • Nicolò de Manzini, MD,
  • Annibale Donini, MD,
  • Mariano Fortunato Armellino, MD,
  • Lucio Taglietti, MD,
  • Gabriele Anania, MD,
  • Mariantonietta Di Cosmo, MD,
  • Carlo Vittorio Feo, MD,
  • Paolo Millo, MD,
  • Corrado Pedrazzani, MD,
  • Silvio Guerriero, MD,
  • Andrea Costanzi, MD,
  • Nereo Vettoretto, MD,
  • Federico Marchesi, MD,
  • Massimo Basti, MD,
  • Graziano Longo, MD,
  • Moreno Cicetti, MD,
  • Paolo Ciano, MD,
  • Michele Benedetti, MD,
  • Leonardo Antonio Montemurro, MD,
  • Maria Sole Mattei, MD,
  • Elena Belloni, MD,
  • Elisa Bertocchi, MD,
  • Gaia Masini, MD,
  • Amedeo Altamura, MD,
  • Francesco Rubichi, MD,
  • Francesco Giudici, MD,
  • Fabio Cianchi, MD,
  • Gabriele Baldini, MD,
  • Ugo Pace, MD,
  • Andrea Fares Bucci, MD,
  • Antonio Sciuto, MD,
  • Desirée Cianflocca, MD,
  • Marco Migliore, MD,
  • Michele Simone, MD,
  • Marcella Lodovica Ricci, MD,
  • Francesco Monari, MD,
  • Alessandro Cardinali, MD,
  • Massimo Sartelli, MD,
  • Marcello Spampinato, MD, PhD, FEBS (HPB),
  • Alessandra Aprile, MD,
  • Domenico Soriero, MD,
  • Gabriella Teresa Capolupo, MD, FACS,
  • Jacopo Andreuccetti, MD,
  • Ilaria Canfora, MD,
  • Andrea Scarinci, MD,
  • Angela Maurizi, MD,
  • Grazia Maria Attinà, MD,
  • Giulia Maggi, MD,
  • Umberto Bracale, MD,
  • Roberto Peltrini, MD,
  • Pietro Amodio, MD,
  • Domenico Spoletini, MD, PhD, FACS,
  • Rosa Marcellinaro, MD,
  • Giovanni Del Vecchio, MD,
  • Massimo Stefanoni, MD,
  • Carmelo Magistro, MD,
  • Diletta Cassini, MD,
  • Lorenzo Crepaz, MD,
  • Andrea Budassi, MD,
  • Bruno Sensi, MD,
  • Silvia Tenconi, MD,
  • Leonardo Solaini, MD,
  • Giorgio Ercolani, MD,
  • Sarah Molfino, MD,
  • Giovanni Domenico De Palma, MD,
  • Paolo Locurto, MD,
  • Antonio Di Cintio, MD,
  • Lorenzo Pandolfini, MD,
  • Alessandro Falsetto, MD,
  • Elisa Cassinotti, MD,
  • Andrea Sagnotta, MD, PhD,
  • Monica Ortenzi, MD,
  • Alberto Biondi, MD,
  • Giacomo Martorelli, MD,
  • Maurizio De Luca, MD,
  • Francesco Carrano, MD,
  • Annalisa Maroli, PhD,
  • Francesca Fior, MD,
  • Antonio Ferronetti, MD,
  • Giuseppe Giuliani, MD,
  • Roberto Benigni, MD,
  • Graziella Marino, MD,
  • Patrizia Marsanic, MD,
  • Nicoletta Sveva Pipitone Federico, MD,
  • Carlo Di Marco, MD,
  • Camillo Leonardo Bertoglio, MD, PhD,
  • Francesca Pecchini, MD,
  • Vincenzo Greco, MD,
  • Michele Motter, MD,
  • Giuseppe Tirone, MD,
  • Marco Clementi, MD,
  • Nicolò Tamini, MD,
  • Riccardo Piagnerelli, MD,
  • Giuseppe Canonico, MD,
  • Simone Cicconi, MD,
  • Marco Colasanti, MD,
  • Enrico Pinotti, MD,
  • Roberta Carminati, MD,
  • Edoardo Osenda, MD,
  • Luigina Graziosi, MD,
  • Ciro De Martino, MD,
  • Giovanna Ioia, MD,
  • Arianna Birindelli, MD,
  • Matteo Chiozza, MD,
  • Daniele Zigiotto, MD,
  • Fioralba Pindozzi, MD,
  • Manuela Grivon, MD,
  • Cristian Conti, MD,
  • Lorenzo Organetti, MD,
  • Michela Monteleone, MD,
  • Emanuele Botteri, MD,
  • Giorgio Dalmonte, MD,
  • Diletta Frazzini, MD,
  • Simone Santoni, MD,
  • Gabriele La Gioia, MD,
  • Diana Giannarelli, MS, PhD

DOI
https://doi.org/10.1097/AS9.0000000000000267
Journal volume & issue
Vol. 4, no. 1
p. e267

Abstract

Read online

Objective:. To evaluate the influence of enhanced recovery pathway (ERP) on patient-reported outcome measures (PROMs) and return to intended oncologic therapy (RIOT) after colorectal surgery. Background:. ERP improves early outcomes after colorectal surgery; however, little is known about its influence on PROMs and on RIOT. Methods:. Prospective multicenter enrollment of patients who underwent colorectal resection with anastomosis was performed, recording variables related to patient-, institution-, procedure-level data, adherence to the ERP, and outcomes. The primary endpoints were PROMs (administered before surgery, at discharge, and 6 to 8 weeks after surgery) and RIOT after surgery for malignancy, defined as the intended oncologic treatment according to national guidelines and disease stage, administered within 8 weeks from the index operation, evaluated through multivariate regression models. Results:. The study included 4529 patients, analyzed for PROMs, 1467 of which were analyzed for RIOT. Compared to their baseline preoperative values, all PROMs showed significant worsening at discharge and improvement at late evaluation. PROMs values at discharge and 6 to 8 weeks after surgery, adjusted through a generalized mixed regression model according to preoperative status and other variables, showed no association with ERP adherence rates. RIOT rates (overall 54.5%) were independently lower by aged > 69 years, ASA Class III, open surgery, and presence of major morbidity; conversely, they were independently higher after surgery performed in an institutional ERP center and by ERP adherence rates > median (69.2%). Conclusions:. Adherence to the ERP had no effect on PROMs, whereas it independently influenced RIOT rates after surgery for colorectal cancer.