Background Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery. However, it is difficult to obtain full adherence to the protocol into clinical practice and has still not been identified the threshold beyond which improved functional results can be reached. Methods The ERCOLE (ERas and COLorectal Endoscopic surgery) study was as a cohort, prospective, multi-centre national study evaluating the association between adherence to ERAS items and clinical outcomes after minimally invasive colorectal surgery. The primary endpoint was to associate the percentage of ERAS adherence to functional recovery after minimally invasive colorectal cancer surgery. The secondary endpoints of the study was to validate safety of the ERAS programme evaluating complications' occurrence according to Clavien-Dindo classification and to evaluate the compliance of the Italian surgeons to each ERAS item. Results 1138 patients were included. Adherence to the ERAS protocol was full only in 101 patients (8.9%), > 75% of the ERAS items in 736 (64.7%) and > 50% in 1127 (99%). Adherence to > 75% was associated with a better functional recovery with 90.2 +/- 98.8 vs 95.9 +/- 33.4 h (p = 0.003). At difference, full adherence to the ERAS components 91.7 +/- 22.1 vs 92.2 +/- 31.6 h (p = 0.8) was not associated with better recovery. Conclusions Our results were encouraging to affirm that adherence to the ERAS program up to 75% could be considered satisfactory to get the goal. Our study could be considered a call to simplify the ERAS protocol facilitating its penetrance into clinical practice.

ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report / Marco, Milone; Ugo, Elmore; Michele, Manigrasso; Monica, Ortenzi; Emanuele, Botteri; Alberto, Arezzo; Silecchia, Gianfranco; Mario, Guerrieri; Giovanni Domenico De Palma, ; Ferdinando, Agresta; Ferdinando, Agresta; Francesco, Pizza; Dario, D???antonio; Francesco, Amalfitano; Francesco, Selvaggi; Guido, Sciaudone; Lucio, Selvaggi; Daniela, Prando; Fabio, Cavallo; Mario, Guerrieri; Monica, Ortenzi; Giovanni, Lezoche; Diego, Cuccurullo; Ernesto, Tartaglia; Carlo, Sagnelli; Andrea, Coratti; Angela, Tribuzi; Michele Di Marino, ; Gabriele, Anania; Cristina, Bombardini; Mauro Pietro Zago, ; Fulvio, Tagliabue; Morena, Burati; Salomone Di Saverio, ; Samuele, Colombo; Sara El Adla, ; Maurizio De Luca, ; Monica, Zese; Dario, Parini; Paolo, Prosperi; Giovanni, Alemanno; Jacopo, Martellucci; Stefano, Olmi; Alberto, Oldani; Matteo, Uccelli; Dario, Bono; Donatella, Scaglione; Roberto, Saracco; Mauro, Podda; Adolfo, Pisanu; Valentina, Murzi; Antonino, Agrusa; Salvatore, Buscemi; Irnerio Angelo Muttillo, ; Biagio, Picardi; Edoardo Maria Muttillo, ; Leonardo, Solaini; Davide, Cavaliere; Giorgio, Ercolani; Francesco, Corcione; Roberto, Peltrini; Umberto, Bracale; Andrea, Lucchi; Laura, Vittori; Michele, Grassia; Alberto, Porcu; Teresa, Perra; Claudio, Feo; Pierluigi, Angelini; Domenico, Izzo; Luigi, Ricciardelli; Mario, Trompetto; Gallo, Gaetano; Alberto Realis Luc, ; Andrea, Muratore; Marcello, Calabr??; Bruno, Cuzzola; Andrea, Barberis; Federico, Costanzo; Giulio, Angelini; Graziano, Ceccarelli; Fabio, Rondelli; Michele De Rosa, ; Elisa, Cassinotti; Luigi, Boni; Ludovica, Baldari; Paolo Pietro Bianchi, ; Giampaolo, Formisano; Giuseppe, Giuliani; Andrea Alessandro Pisani Ceretti, ; Nicol?? Maria Mariani, ; Marco, Giovenzana; Roberto, Farfaglia; Paolo, Marcian??; Valeria, Arizzi; Micaela, Piccoli; Francesca, Pecchini; Gianmaria Casoni Pattacini, ; Emanuele, Botteri; Nereo, Vettoretto; Claudio, Guarnieri; Letizia, Laface; Emmanuele, Abate; Massimiliano, Casati; Carlo, Feo; Nicol??, Fabri; Antonio, Pesce; Piero, Maida; Giampaolo, Marte; Roberta, Abete; Lorenzo, Casali; Alessandro, Marchignoli; Matteo, Dall???aglio; Stefano, Scabini; Davide, Pertile; Alessandra, Aprile; Jacopo, Andreuccetti; Alberto Di Leo, ; Lorenzo, Crepaz; Francesco, Maione; Sara, Vertaldi; Alessia, Chini; Riccardo, Rosati; Francesco, Puccetti; Giulia, Maggi; Andrea, Cossu; Alberto, Sartori; Maurizio De Luca, ; Giacomo, Piatto; Nicola, Perrotta; Marta, Celiento; Marco, Scorzelli; Vincenzo, Pilone; Salvatore, Tramontano; Pietro, Calabrese; Raffaele, Sechi; Nicola, Cillara; Giaime, Putzu; Michele Guido Podda, ; Mauro, Montuori; Enrico, Pinotti; Giuseppe, Sica; Marzia, Franceschilli; Bruno, Sensi; Maurizio, Degiuli; Rossella, Reddavid; Lucia, Puca; Marco, Farsi; Alessio, Minuzzo; Elena, Gia; Gian Luca Baiocchi, ; Valerio, Ranieri; Andrea, Celotti; Francesco, Bianco; Sebastiano, Grassia; Alessandra, Novi. - In: SURGICAL ENDOSCOPY. - ISSN 0930-2794. - 36:10(2022), pp. 7619-7627. [10.1007/s00464-022-09212-y]

ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

Gianfranco Silecchia
Investigation
;
Gaetano Gallo;Federico Costanzo;Edoardo Maria Muttillo
2022

Abstract

Background Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery. However, it is difficult to obtain full adherence to the protocol into clinical practice and has still not been identified the threshold beyond which improved functional results can be reached. Methods The ERCOLE (ERas and COLorectal Endoscopic surgery) study was as a cohort, prospective, multi-centre national study evaluating the association between adherence to ERAS items and clinical outcomes after minimally invasive colorectal surgery. The primary endpoint was to associate the percentage of ERAS adherence to functional recovery after minimally invasive colorectal cancer surgery. The secondary endpoints of the study was to validate safety of the ERAS programme evaluating complications' occurrence according to Clavien-Dindo classification and to evaluate the compliance of the Italian surgeons to each ERAS item. Results 1138 patients were included. Adherence to the ERAS protocol was full only in 101 patients (8.9%), > 75% of the ERAS items in 736 (64.7%) and > 50% in 1127 (99%). Adherence to > 75% was associated with a better functional recovery with 90.2 +/- 98.8 vs 95.9 +/- 33.4 h (p = 0.003). At difference, full adherence to the ERAS components 91.7 +/- 22.1 vs 92.2 +/- 31.6 h (p = 0.8) was not associated with better recovery. Conclusions Our results were encouraging to affirm that adherence to the ERAS program up to 75% could be considered satisfactory to get the goal. Our study could be considered a call to simplify the ERAS protocol facilitating its penetrance into clinical practice.
2022
colorectal; ERAS; enhanced recovery; minimally invasive
01 Pubblicazione su rivista::01a Articolo in rivista
ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report / Marco, Milone; Ugo, Elmore; Michele, Manigrasso; Monica, Ortenzi; Emanuele, Botteri; Alberto, Arezzo; Silecchia, Gianfranco; Mario, Guerrieri; Giovanni Domenico De Palma, ; Ferdinando, Agresta; Ferdinando, Agresta; Francesco, Pizza; Dario, D???antonio; Francesco, Amalfitano; Francesco, Selvaggi; Guido, Sciaudone; Lucio, Selvaggi; Daniela, Prando; Fabio, Cavallo; Mario, Guerrieri; Monica, Ortenzi; Giovanni, Lezoche; Diego, Cuccurullo; Ernesto, Tartaglia; Carlo, Sagnelli; Andrea, Coratti; Angela, Tribuzi; Michele Di Marino, ; Gabriele, Anania; Cristina, Bombardini; Mauro Pietro Zago, ; Fulvio, Tagliabue; Morena, Burati; Salomone Di Saverio, ; Samuele, Colombo; Sara El Adla, ; Maurizio De Luca, ; Monica, Zese; Dario, Parini; Paolo, Prosperi; Giovanni, Alemanno; Jacopo, Martellucci; Stefano, Olmi; Alberto, Oldani; Matteo, Uccelli; Dario, Bono; Donatella, Scaglione; Roberto, Saracco; Mauro, Podda; Adolfo, Pisanu; Valentina, Murzi; Antonino, Agrusa; Salvatore, Buscemi; Irnerio Angelo Muttillo, ; Biagio, Picardi; Edoardo Maria Muttillo, ; Leonardo, Solaini; Davide, Cavaliere; Giorgio, Ercolani; Francesco, Corcione; Roberto, Peltrini; Umberto, Bracale; Andrea, Lucchi; Laura, Vittori; Michele, Grassia; Alberto, Porcu; Teresa, Perra; Claudio, Feo; Pierluigi, Angelini; Domenico, Izzo; Luigi, Ricciardelli; Mario, Trompetto; Gallo, Gaetano; Alberto Realis Luc, ; Andrea, Muratore; Marcello, Calabr??; Bruno, Cuzzola; Andrea, Barberis; Federico, Costanzo; Giulio, Angelini; Graziano, Ceccarelli; Fabio, Rondelli; Michele De Rosa, ; Elisa, Cassinotti; Luigi, Boni; Ludovica, Baldari; Paolo Pietro Bianchi, ; Giampaolo, Formisano; Giuseppe, Giuliani; Andrea Alessandro Pisani Ceretti, ; Nicol?? Maria Mariani, ; Marco, Giovenzana; Roberto, Farfaglia; Paolo, Marcian??; Valeria, Arizzi; Micaela, Piccoli; Francesca, Pecchini; Gianmaria Casoni Pattacini, ; Emanuele, Botteri; Nereo, Vettoretto; Claudio, Guarnieri; Letizia, Laface; Emmanuele, Abate; Massimiliano, Casati; Carlo, Feo; Nicol??, Fabri; Antonio, Pesce; Piero, Maida; Giampaolo, Marte; Roberta, Abete; Lorenzo, Casali; Alessandro, Marchignoli; Matteo, Dall???aglio; Stefano, Scabini; Davide, Pertile; Alessandra, Aprile; Jacopo, Andreuccetti; Alberto Di Leo, ; Lorenzo, Crepaz; Francesco, Maione; Sara, Vertaldi; Alessia, Chini; Riccardo, Rosati; Francesco, Puccetti; Giulia, Maggi; Andrea, Cossu; Alberto, Sartori; Maurizio De Luca, ; Giacomo, Piatto; Nicola, Perrotta; Marta, Celiento; Marco, Scorzelli; Vincenzo, Pilone; Salvatore, Tramontano; Pietro, Calabrese; Raffaele, Sechi; Nicola, Cillara; Giaime, Putzu; Michele Guido Podda, ; Mauro, Montuori; Enrico, Pinotti; Giuseppe, Sica; Marzia, Franceschilli; Bruno, Sensi; Maurizio, Degiuli; Rossella, Reddavid; Lucia, Puca; Marco, Farsi; Alessio, Minuzzo; Elena, Gia; Gian Luca Baiocchi, ; Valerio, Ranieri; Andrea, Celotti; Francesco, Bianco; Sebastiano, Grassia; Alessandra, Novi. - In: SURGICAL ENDOSCOPY. - ISSN 0930-2794. - 36:10(2022), pp. 7619-7627. [10.1007/s00464-022-09212-y]
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