[ERAS protocol for perioperative management of patients with non-small cell lung cancer]. / Opyt primeneniya printsipov ERAS dlya perioperatsionnogo soprovozhdeniya patsientov s nemelkokletochnym rakom legkogo.

OBJECTIVE: To evaluate an effectiveness of enhanced recovery program for perioperative support of patients with lung cancer. MATERIAL AND METHODS: A prospective single-center study on effectiveness of ERAS protocol in perioperative support of patients with lung cancer was conducted at the Tomsk Regional Cancer Center. According to the study design, patients were divided into three groups. The first group included patients after VATS surgery followed by accelerated recovery. The second and the third groups comprised of patients after open interventions. In these groups, patients were randomized into traditional management or accelerated recovery management groups using the blind envelope method. Patients with indicated lobectomy or bilobectomy were included only. In postoperative period, we analyzed morbidity, pain syndrome and hospital-stay. RESULTS: A total of 235 patients were treated. VATS surgery followed by enhanced recovery program was applied in 61 patients. Eighty-seven patients underwent open operations followed by accelerated recovery protocol and traditional management. ERAS protocol ensured less postoperative morbidity compared to traditional management (p<0.001). Pain syndrome was less pronounced after VATS surgery and did not require an appointment of narcotic analgesics. In the group of open surgery followed by accelerated recovery protocol, narcotic analgesics within 3 postoperative days were required in 38 (43.6%) cases, in the group of traditional management - in 63 (72.4%) patients. Mean postoperative hospital-stay after VATS operations was 6.4 days, after open interventions followed by ERAS protocol - 8.7 days. In patients after open surgery and traditional postoperative management, mean hospital-stay was 14.2 days. One patient died after open surgery followed by ERAS protocol and 3 patients died in the group of traditional management. CONCLUSION: ERAS protocol ensures less postoperative morbidity, early activation of patients and reduced hospital-stay.

[Short- and long-term outcomes of laparoscopic interventions in patients with colon cancer: single-centre experience]. / Neposredstvennye i otdalennye rezul'taty laparoskopicheskikh vmeshatel'stv u patsientov s rakom obodochnoi kishki: opyt odnogo tsentra.

OBJECTIVE: To compare short- and long-term outcomes of treatment in patients with colon cancer undergoing laparoscopic and open surgery. MATERIAL AND METHODS: There were 281 patients with colon cancer. All patients underwent open (n=144, 51.2%) or laparoscopic (n=137, 48.8%) procedures. Short- and long-term outcomes of treatment were compared in both groups. RESULTS: There were no significant differences in sex, age, body mass index, location of tumors and tumor differentiation grade in both groups. Conversion was required in 10 (7.2%) cases. The median of duration of surgery was greater for laparoscopic procedures (150 min vs. 130 min; p<0.001). Intraoperative blood loss was significantly less in laparoscopic surgery (100 ml vs. 300 ml; p=0.001). Postoperative mortality was similar (3.5% vs. 2.5%; p=0.5) while incidence of postoperative complications was significantly lower after laparoscopic interventions (13.1% vs. 22.2%; p=0.04). There was earlier recovery of the gastrointestinal tract after laparoscopic procedures (2.1±0.9 days vs. 3.6±1.5 days, respectively; p<0.001). The postoperative hospital-stay was significantly less in the 2nd group (p<0.001). Two-year disease -free and overall survival was similar in both groups. CONCLUSION: Laparoscopic interventions for colon cancer are followed by similar overall and disease-free 2-year survival and better early outcomes.