Early rehabilitation after laparoscopic surgery translates into timely adjuvant chemotherapy for colorectal and gastric cancer

INTRODUCTION: The timing of adjuvant chemotherapy initiation is a critical determinant of oncologic outcomes in colorectal and gastric cancer. Delays beyond 6–8 weeks have been associated with inferior survival. Minimally invasive surgery and enhanced recovery protocols may facilitate earlier rehabilitation and timely initiation of systemic therapy.
METHODS: We retrospectively analyzed 543 patients who underwent curative resection for colorectal (n=396) or gastric cancer (n=147) at Erzurum City Hospital between January 2022 and June 2025. Surgical approach (laparoscopic vs open), perioperative outcomes, Enhanced Recovery After Surgery (ERAS) adherence, complications, and the interval from surgery to adjuvant chemotherapy were assessed. The primary outcome was the initiation of chemotherapy within 6 weeks (≤42 days).
RESULTS: Laparoscopic surgery was performed in 323 (59.5%) patients, while 220 (40.5%) underwent open surgery. ERAS adherence was significantly higher after laparoscopy (median 78 vs 67, p<0.001). Major complications (Clavien–Dindo≥Ⅱ) occurred less frequently in laparoscopic cases (10.8% vs 25.0%). Median length of stay was shorter after laparoscopy (6.4 days vs 9.3 days, p<0.001). Among 370 patients who received adjuvant chemotherapy, the median time-to-chemo was 30 days after laparoscopy versus 39 days after open surgery (p<0.001). The proportion initiating chemotherapy within 6 weeks was significantly higher in the laparoscopic group (94% vs 66%, p<0.001). In multivariable analysis, open surgery (OR 0.20, 95% CI 0.09–0.43, p<0.001) and major complications (OR 0.22, p<0.001) independently predicted failure to commence chemotherapy within 6 weeks.
DISCUSSION AND CONCLUSION: Laparoscopic surgery for colorectal and gastric cancer was associated with higher ERAS adherence, lower morbidity, shorter hospital stay, and earlier initiation of adjuvant chemotherapy compared with open surgery. These findings highlight the importance of minimally invasive approaches and structured perioperative care in optimizing oncologic treatment timelines.