{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:08:19Z","timestamp":1789006099274,"version":"build-2803163510"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":77,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005743","name":"Universit\u00e0 Cattolica del Sacro Cuore","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005743","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Enhanced Recovery After Surgery (ERAS) protocols are widely implemented in colorectal surgery to improve postoperative recovery and reduce hospital stay. However, their impact on postoperative morbidity in elderly and clinically complex populations remains debated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the impact of ERAS implementation on postoperative morbidity and hospital length of stay in an elderly and oncologically complex population undergoing elective laparoscopic colorectal cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective comparative study including patients undergoing elective laparoscopic colorectal cancer resection. Patients treated between January 2016 and December 2018 received standard perioperative care, whereas those treated between January 2022 and December 2025 were managed according to a structured ERAS protocol. All procedures were performed laparoscopically by the same surgical team. To reduce selection bias and improve comparability between cohorts, propensity score matching was performed using age, sex, tumour location, T stage, N stage, and preoperative metastatic disease. The primary endpoint was the incidence of major postoperative complications (Clavien\u2013Dindo grade\u2009\u2265\u2009III). Secondary endpoints included overall postoperative complications, in-hospital\/30-day mortality, and length of hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 209 patients were included (ERAS: 83; non-ERAS: 126). Propensity score matching generated 68 matched pairs, achieving adequate covariate balance (all standardized mean differences\u2009&lt;\u20090.10). In the overall cohort, major complication rates were similar between groups (22.9% vs. 23.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000), as were overall complication rates (59.0% vs. 61.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.876). Mortality did not differ significantly (6.0% vs. 2.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.270). Length of hospital stay was significantly shorter in the ERAS group (6.2\u2009\u00b1\u20092.8 vs. 7.9\u2009\u00b1\u20095.7 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In an elderly and clinically complex population undergoing elective laparoscopic colorectal cancer surgery, ERAS implementation was associated with a significant reduction in hospital length of stay without evidence of increased major postoperative morbidity or mortality. Propensity score matching improved baseline comparability between cohorts. Given the retrospective design and non-contemporaneous study periods, these findings should be interpreted with caution but support the feasibility and safety of ERAS in real-world colorectal surgical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-026-04120-4","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T13:25:04Z","timestamp":1782393904000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of ERAS on morbidity and length of stay in elderly patients undergoing elective laparoscopic colorectal cancer surgery: a two-center comparative study"],"prefix":"10.1007","volume":"411","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3495-6775","authenticated-orcid":false,"given":"Alessandro","family":"Verbo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iacopo","family":"Verbo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"issue":"2","key":"4120_CR1","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","volume":"250","author":"PA Clavien","year":"2009","unstructured":"Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien\u2013Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187\u2013196","journal-title":"Ann Surg"},{"issue":"2","key":"4120_CR2","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. Ann Surg 240(2):205\u2013213","journal-title":"Ann Surg"},{"issue":"6","key":"4120_CR3","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1097\/SLA.0000000000001029","volume":"261","author":"ERAS Compliance Group","year":"2015","unstructured":"ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: Results from an international registry. Ann Surg 261(6):1153\u20131159","journal-title":"Ann Surg"},{"issue":"7","key":"4120_CR4","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1016\/S1470-2045(05)70221-7","volume":"6","author":"R Veldkamp","year":"2005","unstructured":"Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G, Bonjer HJ et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial (COLOR trial). Lancet Oncol 6(7):477\u2013484","journal-title":"Lancet Oncol"},{"issue":"6","key":"4120_CR5","first-page":"1029","volume":"260","author":"RP Merkow","year":"2014","unstructured":"Merkow RP, Bilimoria KY, McCarter MD et al (2014) Post-discharge complications and mortality following colorectal surgery in the United States. Ann Surg 260(6):1029\u20131036","journal-title":"Ann Surg"},{"issue":"3","key":"4120_CR6","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00268-018-4844-y","volume":"43","author":"UO Gustafsson","year":"2019","unstructured":"Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N et al (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS\u00ae) society recommendations: 2018. World J Surg 43(3):659\u2013695","journal-title":"World J Surg"},{"key":"4120_CR7","doi-asserted-by":"crossref","unstructured":"Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJHM (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev (2):CD007635","DOI":"10.1002\/14651858.CD007635.pub2"},{"issue":"6","key":"4120_CR8","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1007\/s00268-013-2416-8","volume":"38","author":"M Greco","year":"2014","unstructured":"Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: A meta-analysis of randomized controlled trials. World J Surg 38(6):1531\u20131541","journal-title":"World J Surg"},{"issue":"4","key":"4120_CR9","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.clnu.2010.01.004","volume":"29","author":"KK Varadhan","year":"2010","unstructured":"Varadhan KK, Neal KR, Dejong CHC, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trials. Clin Nutr 29(4):434\u2013440","journal-title":"Clin Nutr"}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-026-04120-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04120-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04120-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T01:24:36Z","timestamp":1789003476000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00423-026-04120-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4120"],"URL":"https:\/\/doi.org\/10.1007\/s00423-026-04120-4","relation":{},"ISSN":["1435-2451"],"issn-type":[{"value":"1435-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]},"assertion":[{"value":"15 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki. Given the retrospective nature of the study and the use of anonymized data, formal ethical approval was waived according to institutional policy.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"228"}}