Comparison of Short-Term Outcome between Laparoscopic Surgery and Open Surgery with Fast-Track in Patients with Colorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Tinghan ^1,2,3 , WU Fan ^1,2,3 , TANG Zhiyun ^1,2,3 , TAI Yang ^1,2,3 , WANG Xiaodong ^1,2 , LI Li ^1,2

1.Department 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 Medical School, Sichuan University, Chengdu 610041, ChinaCorresponding Author: LI Li, E-mail: drlili116@126.com;

Corresponding author：

Keywords：

Fast-track surgery; Colorectal cancer; Laparoscopic; Short-term outcome

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Objective 　To compare the short-term outcomes between laparoscopic surgery and open surgery with fast-track (FT) in patients with colorectal cancer.
Methods 　Between February 2008 and August 2008, the clinical data of 177 patients with colorectal cancer were analyzed retrospectively, who were divided into open group 　(n=122) and laparoscopic group (n=55) by surgery methods. Open group was further divided into FT group 　(n=66) and traditional group (n=56). Early rehabilitations were studied and compared among three groups.
　Results 　① The baseline characteristics of patients among three groups were no significant differences (P gt;0.05) exclude operation time. ② In early rehabilitation, the first flatus of patients in both the FT group 〔(3.86±1.01) d〕 and the laparoscopic group 〔(3.78±1.10) d〕 was significantly earlier than that in the traditional group 〔(4.43±1.25) d〕, P lt;0.05. ③ The first oral intaking in the FT group 〔(2.52±1.14) d〕 was earlier than that in the traditional group 〔(3.38±1.43) d〕 and the laparoscopic group 〔(5.04±2.24) d〕, P lt;0.05, while in the traditional group was earlier than that in the laparoscopic group (P lt;0.05). ④ For drainage management, both the FT group and the traditional group were significantly earlier than those in the laparoscopic group (P lt;0.05). ⑤ For postoperative hospital stay, in the FT group 〔(8.33±1.98) d〕 was also much shorter than that in the laparoscopic group 〔(10.55±3.14) d〕 and the traditional group 〔(10.82±3.76) d〕, P lt;0.05. ⑥ For the postoperative complications, there was no significant difference among three groups (P gt;0.05).
Conclusions 　FT surgery and laparoscopic technique could both enhance recovery of bowel function, and FT could also shorten postoperative hospital stay. However, further studies are needed to develop a better management.

Citation： YANG Tinghan ,WU Fan,TANG Zhiyun,TAI Yang,WANG Xiaodong,LI Li. Comparison of Short-Term Outcome between Laparoscopic Surgery and Open Surgery with Fast-Track in Patients with Colorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(10): 1097-1101. doi: Copy

1.	The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med, 2004; 350(20): 2050-2059.
2.	Janson M, Bjrholt I, Carlsson P, et al. Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer [J]. Br J Surg, 2004; 91(4): 409-417.
3.	Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial [J]. Lancet, 2004; 363(9416): 1187-1192.
4.	Abraham NS, Byrne CM, Young JM, et al. Meta-analysis of non-randomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer [J]. ANZ J Surg, 2007; 77(7): 508-516.
5.	Schwenk W, Haase O, Neudecker J, et al. Short term benefits for laparoscopic colorectal resection [J]. Cochrane Database Syst Rev, 2005; (3): CD003145.
6.	Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793.
7.	杨廷翰，周寅, 余曦，等. 低位/超低位直肠癌快速流程模式的效果探讨 [J]. 中国普外基础与临床杂志， 2010； 17(6)： 611-615.
8.	李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(一) [J]. 中国普外基础与临床杂志， 2009； 16(5): 413.
9.	李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(二) [J]. 中国普外基础与临床杂志， 2009； 16(6): 493-494.
10.	李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(三) [J]. 中国普外基础与临床杂志， 2009； 16(7): 581.
11.	李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(四) [J]. 中国普外基础与临床杂志， 2009； 16(8): 671.
12.	King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300-308.
13.	李彦良，宋希林，孙现军，等. 腹腔镜与开腹直肠癌根治术短期疗效的临床对比 [J]. 腹腔镜外科杂志， 2010； 15(6): 417-420.
14.	Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
15.	Basse L, Hjort Jakobsen D, Billesblle P, et al. A clinical pathway to accelerate recovery after colonic resection [J]. Ann Surg, 2000; 232(1): 51-57.
16.	Vlug MS, Wind J, van der Zaag E, et al. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme [J]. Colorectal Dis, 2009; 11(4): 335-343.
17.	Polle SW, Wind J, Fuhring JW, et al. Implementation of a fast-track perioperative care program: What are the difficulties? [J]. Dig Surg, 2007; 24(6): 441-449.
18.	Junghans T, Raue W, Haase O, et al. Value of laparoscopic surgery in elective colorectal surgery with “fast-track”-rehabilitation [J]. Zentralbl Chir, 2006; 131(4): 298-303.
19.	李立. 结直肠癌外科应用技术的规范与创新(一) [J]. 中国普外基础与临床杂志， 2006； 13(1): 106-109.
20.	Ishida H, Nakada H, Yokoyama M, et al. Minilaparotomy approach for colonic cancer: initial experience of 54 cases [J]. Surg Endosc, 2005; 19(3): 316-320.
21.	刘展，杨廷翰，余曦，等. 快速流程围手术期临床管理降低结直肠癌手术炎性反应的随机临床研究 [J]. 中国普外基础与临床杂志， 2010； 17(8): 858-863.
22.	Anderson AD, McNaught CE, MacFie J, et al. Randomized clinical trial of multimodal optimization and standard perioperative surgical care [J]. Br J Surg, 2003; 90(12): 1497-1504.
23.	Nygren J, Soop M, Thorell A, et al. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients [J]. Dis Colon Rectum, 2009; 52(5): 978-985.
24.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg, 2002; 183(6): 630-641.
25.	杨廷翰，蒲怡，赵娜，等. 高龄结直肠癌患者快速流程的随机对照研究 [J]. 中国普外基础与临床杂志， 2010； 17(9): 983-988.
26.	Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery; Laparoscopy and/or fast track multimodal management versus standard care (LAFA trial) [J]. BMC Surg, 2006; 6: 16.

1. 　The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med, 2004; 350(20): 2050-2059.
2. 　Janson M, Bjrholt I, Carlsson P, et al. Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer [J]. Br J Surg, 2004; 91(4): 409-417.
3. 　Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial [J]. Lancet, 2004; 363(9416): 1187-1192.
4. 　Abraham NS, Byrne CM, Young JM, et al. Meta-analysis of non-randomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer [J]. ANZ J Surg, 2007; 77(7): 508-516.
5. 　Schwenk W, Haase O, Neudecker J, et al. Short term benefits for laparoscopic colorectal resection [J]. Cochrane Database Syst Rev, 2005; (3): CD003145.
6. 　Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793.
7. 　杨廷翰，周寅, 余曦，等. 低位/超低位直肠癌快速流程模式的效果探讨 [J]. 中国普外基础与临床杂志， 2010； 17(6)： 611-615.
8. 　李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(一) [J]. 中国普外基础与临床杂志， 2009； 16(5): 413.
9. 　李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(二) [J]. 中国普外基础与临床杂志， 2009； 16(6): 493-494.
10. 　李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(三) [J]. 中国普外基础与临床杂志， 2009； 16(7): 581.
11. 　李立，汪晓东，舒晔，等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南(四) [J]. 中国普外基础与临床杂志， 2009； 16(8): 671.
12. 　King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300-308.
13. 　李彦良，宋希林，孙现军，等. 腹腔镜与开腹直肠癌根治术短期疗效的临床对比 [J]. 腹腔镜外科杂志， 2010； 15(6): 417-420.
14. 　Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
15. 　Basse L, Hjort Jakobsen D, Billesblle P, et al. A clinical pathway to accelerate recovery after colonic resection [J]. Ann Surg, 2000; 232(1): 51-57.
16. 　Vlug MS, Wind J, van der Zaag E, et al. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme [J]. Colorectal Dis, 2009; 11(4): 335-343.
17. 　Polle SW, Wind J, Fuhring JW, et al. Implementation of a fast-track perioperative care program: What are the difficulties? [J]. Dig Surg, 2007; 24(6): 441-449.
18. 　Junghans T, Raue W, Haase O, et al. Value of laparoscopic surgery in elective colorectal surgery with “fast-track”-rehabilitation [J]. Zentralbl Chir, 2006; 131(4): 298-303.
19. 　李立. 结直肠癌外科应用技术的规范与创新(一) [J]. 中国普外基础与临床杂志， 2006； 13(1): 106-109.
20. 　Ishida H, Nakada H, Yokoyama M, et al. Minilaparotomy approach for colonic cancer: initial experience of 54 cases [J]. Surg Endosc, 2005; 19(3): 316-320.
21. 　刘展，杨廷翰，余曦，等. 快速流程围手术期临床管理降低结直肠癌手术炎性反应的随机临床研究 [J]. 中国普外基础与临床杂志， 2010； 17(8): 858-863.
22. 　Anderson AD, McNaught CE, MacFie J, et al. Randomized clinical trial of multimodal optimization and standard perioperative surgical care [J]. Br J Surg, 2003; 90(12): 1497-1504.
23. 　Nygren J, Soop M, Thorell A, et al. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients [J]. Dis Colon Rectum, 2009; 52(5): 978-985.
24. 　Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg, 2002; 183(6): 630-641.
25. 　杨廷翰，蒲怡，赵娜，等. 高龄结直肠癌患者快速流程的随机对照研究 [J]. 中国普外基础与临床杂志， 2010； 17(9): 983-988.
26. 　Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery; Laparoscopy and/or fast track multimodal management versus standard care (LAFA trial) [J]. BMC Surg, 2006; 6: 16.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Short-Term Outcome between Laparoscopic Surgery and Open Surgery with Fast-Track in Patients with Colorectal Cancer

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