Enhanced Recovery After Surgery Versus Conventional Care in Simultaneous Colorectal Resection and Hepatectomy for Synchronous Colorectal Liver Metastases.

Abstract

Evidence regarding the feasibility and outcomes of enhanced recovery after surgery (ERAS) programs in patients undergoing simultaneous colorectal resection and hepatectomy remains limited. This study aimed to evaluate the impact of ERAS implementation on perioperative and oncologic outcomes in patients undergoing simultaneous colorectal resection and hepatectomy for synchronous colorectal liver metastases. A single-center retrospective cohort study was conducted involving 100 consecutive patients who underwent elective simultaneous colorectal resection and hepatectomy before (n = 50) and after (n = 50) ERAS implementation. Outcomes included postoperative complications, length of stay, hospital cost, disease-free survival, and overall survival. The mean age was 63 years, and 55% were male. Rectal cancer was the primary tumor in 38 patients, and 18 patients required major hepatectomy. Baseline characteristics and operative details were comparable between the ERAS and conventional care groups. ERAS implementation significantly reduced postoperative complications (22% vs. 42% and p = 0.032) and time to tolerate a solid diet (3 vs. 5 days and p = 0.001). Median postoperative length of stay was shorter in the ERAS group (6 days [IQR 5-9] vs. 8 days [IQR 6-16] and p = 0.005). Average hospital cost was slightly lower with ERAS (4815 USD vs. 5298 USD and p = 0.446). Five-year overall and disease-free survival rates were similar between groups (86.7% vs. 88.9%; p = 0.583 and 44.4% vs. 48.9%; p = 0.724, respectively). ERAS implementation in simultaneous colorectal resection and hepatectomy resulted in shorter hospitalization, faster bowel recovery, and a modest reduction in cost, while maintaining comparable long-term oncologic outcomes.