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Table 1 ERAS protocol used in our unit

From: Enhanced Recovery After Surgery (ERAS®) protocol in patients undergoing laparoscopic resection for stage IV colorectal cancer

1. Preoperative counselling and patient’s education

2. No bowel preparation (oral lavage in the case of low rectal resection with TME and defunctioning loop ileostomy)

3. Preoperative carbohydrate loading (400 ml of Nutricia preOp® 2 h prior surgery)

4. Antithrombotic prophylaxis (Clexane® 40 mg sc. starting in the evening prior surgery)

5. Antibiotic prophylaxis (preoperative cefuroxime 1.5 g + metronidazole 0.5 g i.v. 30–60 min prior surgery)

6. Laparoscopic surgery

7. Balanced intravenous fluid therapy (<2500 ml intravenous fluids during the day of surgery, less than 150 mmol sodium)

8. No nasogastric tubes postoperatively

9. No drains left routinely for colonic resections, one drain placed for <24 h in case of TME

10. TAP (transversus abdominis plane) block, epidural anaesthesia in cases with high risk of conversion

11. Avoiding opioids, multimodal analgesia (oral when possible—paracetamol 4 × 1 g, ibuprofen 2 × 200 mg, metamizole 2 × 2.5 g, or ketoprofen 2 × 100 mg)

12. Prevention of postoperative nausea and vomiting (PONV) (dexamethasone 8 mg i.v., ondansetron 8 mg i.v., metoclopramide 10 mg i.v.)

13. Postoperative oxygenation therapy (4–6 l/min.)

14. Early oral feeding (oral nutritional supplement 4 h postoperatively, light hospital diet and oral nutritional supplements on the first postoperative day, full hospital diet in the second postoperative day)

15. Urinary catheter removal on the first postoperative day

16. Full mobilisation on the first postoperative day (getting out of bed, going to toilet, walking along the corridor, at least 4 h out of bed)