The role of enhanced recovery after surgery (ERAS) protocol on resectable gastrointestinal cancer during COVID-19 pandemic crisis: a prospective study during pandemic

ABSTRACT

BackgroundThis worldwide new COVID-19 pandemic has a great impact on our gastrointestinal oncology clinical practice, many restrictions for elective and emergency management, especially on GI cancer already been applied in every referred hospital. Current guidelines suggest postponing elective surgery for those cases. But in some instances, we must perform surgery for some reasons, including untreatable pain or impending obstruction. Enhanced recovery after surgery might have an important role in increasing the favorable outcome for these patients.MethodsThis prospective study was done for the last 4 months from March 2020. All resectable GI cancer patients have been included in this study, ERAS protocols have been applicated for perioperative management. The main outcome was the length of stay, readmission rate, post-operative complications and in hospital mortality. Prior neoadjuvant chemotherapy will be excluded from this study.ResultsDuring the last 4 months, we reported 45 cases of resectable GI cancer, 28 cases needed emergency surgery and the others had an elective resection. ERAS protocols have been applied during this pandemic. Right colectomy, Anterior resection and Low Anterior resection with primary anastomosis were the most common surgeries performed. The other procedures were retroperitoneal tumor resection. The main length of stay was 4.5 days, and no leak anastomosis was reported. 1 patient has not survived the prolonged sepsis condition from the closed-loop obstruction of rectal cancer.ConclusionsERAS protocol for GI cancer during the COVID-19 pandemic was safe, and feasible, and it would reduce the length of stay and be applicable for this prolonged pandemic.