Fast-track laparoscopic surgery: A better option for treating colorectal cancer than conventional laparoscopic surgery

Taupyk,Yerlan; Cao,Xueyuan; Zhao,Yinquan; Wang,Chao; Wang,Quan

doi:10.3892/ol.2015.3166

Fast-track laparoscopic surgery: A better option for treating colorectal cancer than conventional laparoscopic surgery

Authors:
- Yerlan Taupyk
- Xueyuan Cao
- Yinquan Zhao
- Chao Wang
- Quan Wang
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Affiliations: Department of Gastric and Colorectal Surgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
Published online on: April 29, 2015 https://doi.org/10.3892/ol.2015.3166
Pages: 443-448

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Abstract

Fast-track surgery (FTS), a multimodal rehabilitation technique, has been recommended as surgical therapy for colorectal cancer. The objective of the present study was to compare the outcomes of FTS and conventional laparoscopic surgery. This study was a blinded randomized trial. A total of 70 patients with colorectal cancer were divided into two groups and underwent laparoscopic colorectal resection. The FTS group consisted of 31 patients and the control group consisted of 39 patients. Protocols for the treatment of the FTS group included skipping pre‑operative mechanical bowel preparation, early restoration of diet and early post‑operative ambulation. Outcome measures, length of hospital stay, post‑operative surgical stress response [C‑reactive protein (CRP)] and post‑operative complications were compared between the two groups. The average length of total hospital stay for the FTS and the control groups was 5.9±0.8 and 10.9±1.3 days, respectively (P<0.05), and the length of post‑operative hospital stay for the FTS and control group was 4.3±0.8 and 8.0±1.1 days, respectively. (P<0.05) First flatus time for the FTS and control groups was 1.6±0.8 and 2.5±0.9 days, respectively (P<0.05). Defecation time for the FTS and control groups was 2.2±0.7 and 4.5±0.7 days, respectively (P<0.05). The time to restoration of a solid diet also showed a significant difference between the FTS and control groups (1.1±0.3 vs. 3.6±0.9 days; P<0.05). Following surgery, due to post‑operative surgical stress, the two groups CRP levels increased significantly, but the levels of the FTS group were lower than those of the conventional control group (P<0.05). There was no difference in post‑operative complications between the FTS and control groups. This study confirms that FTS shortens hospital stay and accelerates the recovery of bowel function without increase of post‑operative complications. FTS is safe, improves post‑operative recovery and is a better option than conventional laparoscopic surgery for treating colorectal cancer patients.

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1	Kehlet H: Fast-track colorectal surgery. Lancet. 371:791–793. 2008. View Article : Google Scholar : PubMed/NCBI
2	Holte K and Kehlet H: Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutirion. Clin Nutr. 21:199–206. 2002. View Article : Google Scholar : PubMed/NCBI
3	Raue W, Haase O, Junghans T, et al: ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: A controlled prospective evaluation. Surg Endosc. 18:1463–1468. 2004. View Article : Google Scholar : PubMed/NCBI
4	Scatizzi M, Kröning KC, Boddi V, et al: Fast-track surgery after laparoscopic colorectal surgery: Is it feasible in a general surgery unit? Surgery. 147:219–226. 2010. View Article : Google Scholar : PubMed/NCBI
5	Wang G, Jiang ZW, Xu J, Gong JF, Bao Y, Xie LF and Li JS: Fast-track rehabilitation program vs conventional care after colorectal resection: A randomized clinical trial. World J Gastroenterol. 17:671–676. 2011. View Article : Google Scholar : PubMed/NCBI
6	Wang Q, Suo J, Jiang J, Wang C, Zhao YQ and Cao X: Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: A randomized trial. Colorectal Dis. 14:1009–1013. 2012. View Article : Google Scholar : PubMed/NCBI
7	Edge S, Byrd DR, Compton CC, et al: AJCC Cancer Staging Manual. 7th. Springer; New York, NY: 2010
8	Kelley SR, Wolff BG, Lovely JK and Larson DW: Fast-track pathway for minimally invasive colorectal surgery with and without alvimopan (Entereg)™: Which is more cost-effective? Am Surg. 79:630–633. 2013.PubMed/NCBI
9	Baek SJ, Kim SH, Kim SY, Shin JW, Kwak JM and Kim J: The safety of a ‘fast-track’ program after laparoscopic colorectal surgery is comparable in older patients as in younger patients. Surg Endosc. 27:1225–1232. 2013. View Article : Google Scholar : PubMed/NCBI
10	Sommer T, Larsen JF and Raundahl U: Eliminating learning curve-related morbidity in fast track laparoscopic Roux-en-Y gastric bypass. J Laparoendosc Adv Surg Tech A. 21:307–312. 2011. View Article : Google Scholar : PubMed/NCBI
11	British Medical Association Health Policy and Economic Research Unit, . Work related stress among senior doctors - review of research. London: BMA; 2000
12	Pineda CE, Shelton AA, Hernandez-Boussard T, Morton JM and Welton ML: Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg. 12:2037–2044. 2008. View Article : Google Scholar : PubMed/NCBI
13	Bucher P, Gervaz P, Soravia C, Mermillod B, Erne M and Morel P: Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg. 92:409–414. 2005. View Article : Google Scholar : PubMed/NCBI
14	Nygren J, Thorell A and Ljungqvist O: Preoperative oral carbohydrate nutrition: An update. Curr Opin Clin Nutr Metab Care. 4:255–259. 2001. View Article : Google Scholar : PubMed/NCBI
15	Ljungqvist O, Nygren J and Thorell A: Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. In: Proc Nutr Soc. 61. pp. 329–336. 2002; View Article : Google Scholar : PubMed/NCBI
16	Brady M, Kinn S and Stuart P: Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. CD0044232003.PubMed/NCBI
17	Mathur S, Plank LD, McCall JL, Shapkov P, McIlroy K, Gillanders LK, Merrie AE, Torrie JJ, Pugh F, Koea JB, Bissett IP and Parry BR: Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg. 97:485–494. 2010. View Article : Google Scholar : PubMed/NCBI
18	Andersen HK, Lewis SJ and Thomas S: Early enteral nutrition within 24 h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev. CD0040802006.PubMed/NCBI
19	Morończyk DA and Krasnodębski IW: Implementation of the fast track surgery in patients undergoing the colonic resection: Own experience. Pol Przegl Chir. 83:482–487. 2011.PubMed/NCBI
20	Gouvas N, Gogos-Pappas G, Tsimogiannis K, Tsimoyiannis E, Dervenis C and Xynos E: Implementation of fast-track protocols in open and laparoscopic sphincter-preserving rectal cancer surgery: A multicenter, comparative, prospective, non-randomized study. Dig Surg. 29:301–309. 2012. View Article : Google Scholar : PubMed/NCBI
21	Gouvas N, Tan E, Windsor A, Xynos E and Tekkis PP: Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis. 24:1119–1131. 2009. View Article : Google Scholar : PubMed/NCBI
22	Wind J, Polle SW, Fung Kon, Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ and Bemelman WA: Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group; Enhanced Recovery After Surgery (ERAS) Group: Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 93:800–809. 2006. View Article : Google Scholar : PubMed/NCBI
23	Gatt M, Khan S and MacFie J: In response to: Varadhan KK Neal KR Dejong CH Fearon KC Ljungqvist O Lobo DN The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 29:2010.434–440 Clin Nutr. 29:689–692. 2010. View Article : Google Scholar : PubMed/NCBI
24	Feroci F, Lenzi E, Baraghini M, Garzi A, Vannucchi A, Cantafio S and Scatizzi M: Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech. 23:259–265. 2013. View Article : Google Scholar : PubMed/NCBI
25	Feroci F, Baraghini M, Lenzi E, Garzi A, Vannucchi A, Cantafio S and Scatizzi M: Laparoscopic surgery improves postoperative outcomes in high-risk patients with colorectal cancer. Surg Endosc. 27:1130–1137. 2013. View Article : Google Scholar : PubMed/NCBI