Relationship of FastTrack Perioperative Period Clinical Care Mode and Inflammatory Response in Colorectal Operation. A Randomized Clinical Trial_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Zhan ^1,2 , YANG Tinghan ^1,3,4 , YU Xi ^1,3,4 , LI Wei ^1,3,5 , WANG Xiaodong ^1,3 , LI Li ^1,3

1.Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 61004, China;;
2.Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu 610031, China;;
3.West China Hospital MCQ Team, Sichuan University, Chengdu 610041, China;;
4.West China Medical School, Sichuan University, Chengdu 610041, China;;
5.West China College of Stomatology, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Colorectal surgery; Fast-track; Perioperative period clinical care; Inflammatory response; Randomized clinical trial

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Objective To evaluate the effect of perioperative period clinical care mode through fast-track (FT) under nonminimal invasive operation on the inflammatory response of colorectal cancer resection.
Methods Fifty-five patients underwent elective colorectal cancer resection were randomized divided into two groups: FT group (n=29) in which patients were performed FT perioperative care and tradition group (n=26) in which patients were received traditional perioperative care. The nonminimal invasive operations were performed in this study. The venous blood samples were respectively collected at 24 h before operation, at 24 h, 72 h, and 7 d after operation, and were used to detect the concentrations of serum C-reactive protein (CRP) and serum amyloid A protein (SAA).
Results There was no complication such as infection, fistula of stoma and inflammatory ileus that was potential to influence the study results in two groups, and no patient died. The trend of changes in the concentrations of CRP and SAA of patients was accordant in each group. The peak concentrations of CRP and SAA of patients in FT group were respectively observed at 24 h after operation 〔CRP: (72.36±60.94) mg/L; SAA: (328.97±267.20) mg/L〕, while which were respectively delayed to 72 h after operation in tradition group 〔CRP: (112.71±63.92) mg/L; SAA: (524.18±331.03) mg/L〕. At the same time, the concentrations of CRP and SAA in FT group began to descend 〔CRP: (57.21±30.42) mg/L; SAA: (237.43±215.66) mg/L〕. The peak concentrations of CRP and SAA in tradition group were significantly higher than that in FT group (P lt;0.001) and the concentrations of CRP and SAA in FT group were significantly lower than those in tradition group at 72 h after operation (P lt;0.001). On 7 d after operation, the concentrations of CRP and SAA further decreased, but the difference between two groups was not significant (P gt;0.05). Likewise, the concentrations of CRP and SAA at 7 d after operation were significant higher than those 24 h and 72 h after operation (P lt;0.001), lower than that 24 h before operation (P lt;0.001), respectively.
Conclusion This study demonstrates that perioperative period clinical care mode through FT under non-minimal invasive operation can reduce the inflammatory response of colorectal carcinoma resections and scientific clinical care is an important means to promote quick rehabilitation.

Citation： LIU Zhan ,YANG Tinghan,YU Xi,LI Wei,WANG Xiaodong,LI Li. Relationship of FastTrack Perioperative Period Clinical Care Mode and Inflammatory Response in Colorectal Operation. A Randomized Clinical Trial. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(8): 855-859下转864. doi: Copy

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1. 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241.
2. 许剑民, 钟芸诗, 朱德祥, 等. 促进术后恢复综合方案在结直肠癌根治术中的应用 [J]. 中华胃肠外科杂志, 2007; 10(3): 238244.
3. 刘展，汪晓东，李立. 结直肠外科快速流程内容及依据 [J]. 中国普外基础与临床杂志, 2007; 14(4): 469473.
4. Kehlet H. Surgical stress response: does endoscopic surgery confer an advantage? [J]. World J Surg, 1999; 23(8): 801807.
5. Nakagoe T, Tsuji T, Sawai T, et al. Minilaparotomy may be independently associated with reduction in inflammatory responses after resection for colorectal cancer [J]. Eur Surg Res, 2003; 35(6): 477485.
6. Wind J, Polle SW, Fung Kon Jin PH, et al. Systematic review of enhanced recovery programmes in colonic surgery [J]. Br J Surg, 2006; 93(7): 800809.
7. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acutephase reactant for clinical practice [J]. Eur J Clin Invest, 1996; 26(6): 427435.
8. Adlouni A, Ghalim N, Sale R, et al. Beneficial effect on serum apo AI, apo B and Lp AI levels of Ramadan fasting [J]. Clin Chim Acta, 1998; 271(2): 179189.
9. Reismann M, von Kampen M, Laupichler B, et al. Fasttrack surgery in infants and children [J]. J Pediatr Surg, 2007; 42(1): 234238.
10. Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fasttrack surgery: what can be expected? [J]. Am J Surg, 2009; 197(3): 408412.
11. Feo CV, Lanzara S, Sortini D, et al. Fast track postoperative management after elective colorectal surgery: a controlled trial [J]. Am Surg, 2009; 75(12): 12471251.
12. 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.
13. Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [J]. Lancet, 2007; 370(9605): 21122117.
14. Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
15. PenaSoria MJ, Mayol JM, Anula R, et al. Singleblinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis [J]. J Gastrointest Surg, 2008; 12(12): 21032109.
16. Pineda CE, Shelton AA, HernandezBoussard T, et al. Mechanical bowel preparation in intestinal surgery: a metaanalysis and review of the literature [J]. J Gastrointest Surg, 2008;12(11): 20372044.
17. Cheatham ML, Chapman WC, Key SP, et al. A metaanalysis of selective versus routine nasogastric decompression after elective laparotomy [J]. Ann Surg, 1995; 221(5): 469478.
18. Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and metaanalysis [J]. Ann Surg, 1999; 229(2): 174180.
19. Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer [J].Ann Surg, 2007; 245(6): 867872.
20. Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus [J]. World J Surg, 2006; 30(8): 13821391.
21. Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operationis it evidencebased? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 4554.
22. Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery [J]. Proc Nutr Soc, 2003; 62(4): 807811.
23. Kuzma J. Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioidsparing analgesia versus traditional care after open appendectomy [J]. Clin Nutr, 2008; 27(5): 694699.
24. HanGuerts IJ, Hop WC, Kok NF, et al. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery [J]. Br J Surg, 2007; 94(5): 555561.
25. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study [J]. Ann Surg, 2005; 241(3): 416423.
26. 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.
27. 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Relationship of FastTrack Perioperative Period Clinical Care Mode and Inflammatory Response in Colorectal Operation. A Randomized Clinical Trial

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