Clinical Outcome of Fast-Track Surgery for Low/Super-Low Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Tinghan ^1,2,3 , ZHOU Yin ^1,2,3 , YU Xi ^1,2,3 , HAO Jin ^1,2,4 , WANG Xiaodong ^1,2 , LI Li ^1,2

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 Medical School/West China Hospital， Sichuan University, Chengdu 610041, China;;
4. West China College of Stomatology, Sichuan University, Chengdu 610041, China.;

Corresponding author：

Keywords：

Rectal cancer; Fast-track; Enhanced recovery program; Low anterior resection

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Objective To discuss the clinical outcome of fast-track surgery for low/super-low rectal cancer. Methods Between October 2007 and December 2008, 120 patients underwent low/super-low rectal cancer resection without formation of stoma in the West China Hospital were analyzed retrospectively. Postoperative early rehabilitations were compared between fast-track group and traditional group. Results In early rehabilitations, time of first passing flatus, ambulation, oral intake, and pulling out urinary catheter and the hospital stay in fast-track group were significantly earlier than those in traditional group （P lt;0.05）, while there was no significant difference in time of using nasogastric tubes or drains （P gt;0.05）. There was also no significant difference in postoperative morbidity of complications between the 2 groups （P gt;0.05）. Conclusion Fast-track surgery for low/super-low rectal cancer is safe and can accelerate recovery with decreased length of hospital stay.

Citation： YANG Tinghan,ZHOU Yin,YU Xi,HAO Jin,WANG Xiaodong,LI Li. Clinical Outcome of Fast-Track Surgery for Low/Super-Low Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 618-621. doi: Copy

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13.	Hasenberg T, Keese M, Lngle F, et al. ‘Fast-track’ colonic surgery in Austria and Germany-results from the survey on patterns in current perioperative practice [J]. Colorectal Dis, 2009; 11(2): 162-167.
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17.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg, 2002; 183(6): 630-641.
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1. Kehlet H. Fast-track colorectal surgery [J]. Lancet， 2008; 371(9615): 791-793.
2. 汪晓东，谢尧，肖军，等. 快速流程在结直肠外科手术后管理中的应用 [J]. 中国普通外科杂志， 2008； 17（4）： 394-396.
3. Basse L, Thorbl JE, Lssl K, et al. Colonic surgery with accelerated rehabilitation or conventional care[J]. Dis Colon Rectum, 2004; 47(3): 271-277.
4. Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection [J]. Dis Colon Rectum, 2003; 46(7): 851-859.
5. 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.
6. 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.
7. 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 [J]. 中国普外基础与临床杂志, 2009; 16(5-8): 413, 493-494, 581, 671.
8. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
9. Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971-975.
10. 肖凌，李蔚，麦玲，等. 快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响 [J]. 中国普外基础与临床杂志， 2010； 17（2）： 190-194.
11. 李立. 结直肠癌外科应用技术的规范与创新（四） [J]. 中国普外基础与临床杂志， 2006； 13（4）： 461-468.
12. 周寅，杨廷翰，汪晓东，等. 早期经口进食在结直肠癌术后快速流程模式中的应用 [J]. 中国普外基础与临床杂志， 2010； 17(5): 500-503.
13. Hasenberg T, Keese M, Lngle F, et al. ‘Fast-track’ colonic surgery in Austria and Germany-results from the survey on patterns in current perioperative practice [J]. Colorectal Dis, 2009; 11(2): 162-167.
14. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2007; (3): CD004929.
15. Petrowsky H, Demartines N, Rousson V, et al. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses [J]. Ann Surg, 2004; 240(6): 1074-1084.
16. 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.
17. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg, 2002; 183(6): 630-641.
18. Gatt M, Anderson AD, Reddy BS, et al. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection [J]. Br J Surg, 2005; 92(11): 1354-1362.
19. Raue W, Haase O, Junghans T, et al. ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation [J]. Surg Endosc, 2004; 18(10): 1463-1468.
20. Bradshaw BG, Liu SS, Thirlby RC. Standardized perioperative care protocols and reduced length of stay after colon surgery [J]. J Am Coll Surg, 1998; 186(5): 501-506.
21. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466-477.
22. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Outcome of Fast-Track Surgery for Low/Super-Low Rectal Cancer

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