Enhanced recovery after surgery and long-term oncologic outcomes: post-hoc analysis of the POWER study.

Introduction/objectives: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality. While Enhanced Recovery After Surgery (ERAS) programs optimize perioperative care, their effect on oncologic prognosis requires further validation. This study evaluates ERAS adherence and five-year survival through a post-hoc analysis of the POWER Study.

Methods: This sub-analysis included 901 patients from 32 hospitals with available 5-year follow-up data. Patients undergoing elective CRC resection were stratified based on ERAS adherence (≥70%). Primary outcomes included overall survival and recurrence rates analysed using Cox proportional hazards models adjusted for clinical variables. Kaplan-Meier curves and subgroup analyses were also performed to assess stage-specific differences.

Results: No significant differences were observed in 5-year overall survival (ERAS 66% vs. non-ERAS 60%; HR: 1.14, 95% CI: 0.88-1.49; P = 0.32) or recurrence rates (ERAS 25% vs. non-ERAS 25%; HR: 0.91, 95% CI: 0.68-1.22; P = 0.53). Kaplan-Meier curves showed overlapping survival trajectories, and subgroup analyses confirmed no stage-specific disparities. While ERAS promotes early postoperative recovery and facilitates timely adjuvant therapy initiation, its effect on long-term oncologic outcomes remains inconclusive.

Conclusions: These findings support ERAS as a safe perioperative strategy that enhances short-term recovery without compromising oncologic safety. However, limitations such as the post-hoc design and incomplete long-term data warrant further research. Future studies should investigate ERAS's impact on perioperative stress, immune function, and recurrence prevention to better elucidate its role in long-term CRC outcomes.