Clinical Effects of Different Strategies for Surgical Treatment of Rectal Cancer Patients Combined with Restrict Rehydration in Fast-Track_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIAO Ling ^1,2,3 , LI Wei ^1,2,3 , MAI Ling ^1,2 , WANG Xiaodong ¹ , LI Li ¹

1.Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041， China;;
2.West China Hospital MCQ Team, Sichuan University, Chengdu 610041， China;;
3.West China College of Stomatology, Sichuan University, Chengdu 610041， China;

Corresponding author：

Keywords：

Restriction rehydration; Surgery; Rectal cancer; Fast-track

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the clinical effect of different strategies for surgical treatment combined with restrict rehydration on rehabilitation of rectal cancer patients in fast-track.
Methods From January 2008 to January 2009, the patients diagnosed definitely as rectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different surgical programs 〔high anterior resection (HAR), low anterior resection (LAR)〕.
Results The difference of first aerofluxus, first defecation, postoperative first eating and first ambulation between fluid restriction group and tradition therapy group was statistically significant (P lt;0.05). And the difference of first aerofluxus, first defecation and post-operative first eating between HAR group and LAR group in tradition therapy group was statistically significant (P lt;0.05). Regarding to the overall incidence of postoperative complications, the incidence of pulmonary infection, wound infection and intestinal obstruction in tradition therapy group were higher than that in fluid restriction group (P lt;0.05). And in tradition therapy group, the difference in the incidence of intestinal obstruction between LAR group and HAR group was not statistically significant (P gt;0.05). The difference of early recovery and postoperative complications between HAR group and LAR group in fluid restriction group had no statistical significance (P gt;0.05).
Conclusion Different strategies for surgical treatment of rectal cancer patients combined with restrict rehydration in fasttrack is feasible and can promote early rehabilitation of patients.

Citation： XIAO Ling ,LI Wei,MAI Ling,WANG Xiaodong,LI Li. Clinical Effects of Different Strategies for Surgical Treatment of Rectal Cancer Patients Combined with Restrict Rehydration in Fast-Track. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(2): 190-194. doi: Copy

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14.	Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
15.	肖凌，汪晓东，李立. 术后液体管理在结直肠外科快速流程中的应用进展 [J]. 中国普外基础与临床杂志, 2009; 16(7): 593596.
16.	Moller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 5762.
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20.	von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
21.	Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
22.	Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg， 2006; 93(9): 10691076.
23.	Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
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25.	Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.

1. Schwenk W, Haase O, Raue W, et al. Establishing “fasttrack” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129 (6): 502509.
2. 刘展，汪晓东，李立. 多学科协作诊治模式下的结直肠外科快速康复流程 [J]. 中国普外基础与临床杂志, 2007; 14(2): 239242.
3. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 18121818.
4. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. The danish study group on perioperative fluid therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg， 2003; 238(5): 641648.
5. Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review [J]. Dig Surg, 2008; 25(2)： 148157.
6. 吴在德, 吴肇汉. 外科学 [M]. 第7版. 北京: 人民卫生出版社, 2008： 66.
7. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
8. 李立，汪晓东，舒晔，等. 四川大学华西医院·结直肠癌手术治疗指南(二) [J]. 中国普外基础与临床杂志, 2008; 15(11): 861862.
9. 吕东昊，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志, 2007; 14(6): 713716.
10. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3)： 355360.
11. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
12. Gan TJ, Soppitt A, Maroof M, et al. Goaldirected intraoperative fluid administration reduces length of hospital stay after major surgery [J]. Anesthesiology, 2002; 97(4): 820826.
13. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg， 2005; 101(2): 601605.
14. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
15. 肖凌，汪晓东，李立. 术后液体管理在结直肠外科快速流程中的应用进展 [J]. 中国普外基础与临床杂志, 2009; 16(7): 593596.
16. Moller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 5762.
17. MacKay G, Fearon K, McConnachie A, et al . Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 14691474.
18. Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 15041509.
19. Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
20. von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
21. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
22. Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg， 2006; 93(9): 10691076.
23. Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
24. HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med， 1997; 23(3): 276281.
25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Effects of Different Strategies for Surgical Treatment of Rectal Cancer Patients Combined with Restrict Rehydration in Fast-Track

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