The British journal of surgeryMar 13, 2019

How faster recovery programs may affect cancer results after less invasive rectal cancer surgery

Gut-Brain Axis Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 31, 2026

Abstract

Of the 600 patients who underwent minimally invasive surgery for rectal cancer, 53.3 percent were treated according to an enhanced recovery pathway (ERP).

ERP was linked to lower overall morbidity, with rates of 34.7 percent compared to 54.3 percent for conventional care.
At five years, overall survival was higher in the ERP group (91.4 percent) compared to the conventional group (81.7 percent) based on univariable analysis.
Multivariable analysis showed no significant difference in overall survival between ERP and conventional care.
Independent risk factors affecting overall survival included age, male sex, and complications.
Disease-free survival rates were similar between ERP (80.5 percent) and conventional treatment (84.6 percent) at five years.

Simplified

BACKGROUND: Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer.

METHODS: This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care.

RESULTS: A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272).

CONCLUSION: Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.

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How faster recovery programs may affect cancer results after less invasive rectal cancer surgery

Abstract

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