Implementation of enhanced recovery after surgery and its increasing compliance improved 5-year overall survival in resectable stage III colorectal cancer.

PURPOSE: Enhanced recovery after surgery (ERAS) improves short-term outcomes after colorectal cancer (CRC) surgery, but its benefits on oncological results remain unclear. The objectives of this study are (1) to compare 5-year overall survival (OS) following non-metastatic CRC surgery between ERAS and conventional care (CC), and (2) to evaluate the association between ERAS compliance and OS. METHODS: Patients undergoing curative resection for stage I-III CRC in a university hospital were reviewed. Utilizing the 2010-2012 CRC registry, 5-year OS of surgical patients between ERAS and CC were compared. Utilizing the 2010-2016 ERAS registry, 5-year OS between patients with high ERAS compliance (≥ 70%) and their counterparts were compared. RESULTS: Between 2010 and 2012, 349 patients had curative surgery: 70 (20%) with ERAS and 279 (80%) with CC. The 5-year OS was 80.3% in ERAS and 65.6% in CC (HR 0.54, 95%CI 0.33-0.88, p = 0.014). After adjustment with other variables, ERAS was associated with better 5-year OS for stage III CRC only (72.6% vs. 57.2%, adjusted HR 0.54, 95%CI 0.30-0.98, p = 0.041). Regarding ERAS compliance, 320 patients were reviewed: 232 (73%) with high compliance. The 5-year OS was 83.9% in high compliance and 69.6% in low compliance (HR 0.49, 95% CI 0.29-0.83, p = 0.007). After adjustment with cancer staging, high compliance had better 5-year OS in stage III CRC only (80.5% vs. 60.7%, adjusted HR 0.44, 95%CI 0.23-0.84, p = 0.013). CONCLUSION: ERAS was associated with improved 5-year OS following non-metastatic CRC surgery (especially stage III disease) than CC. High ERAS compliance had better OS than its counterpart.

Left Paraduodenal Hernia As a Rare Cause of Small Bowel Obstruction in Elderly: A Case Report and Review of Literature.

The authors presented a case of left paraduodenal hernia as a cause of closed loop small bowel obstruction in an elderly patient. Internal hernias are a rare cause of intestinal obstruction. Paraduodenal hernias are the most frequent especially left sided, which are believed to be the result of malrotation of the midgut during embryonic period. The clinical presentations varied, ranging from asymptomatic, chronic abdominal pain, or acute abdominal pain as acute abdomen. Most of the patients usually have early presentation in adult life with average age of 38.5 years at time of diagnosis. Late presentation in elderly patient (> 70 years) is very rare due to its congenital in origin. This clinical entity is a diagnostic challenge, which happened in our case. When the diagnosis is late, the complication develops and may contribute to afatal outcome if left untreated Herein, the authors reported our case of left paraduodenal hernia with late presentation at age of 80, and reviewed literature.