Objective To discuss the impacts of completion rate of fast track items on postoperative management of colorectal cancer surgery. Methods Between February 2010 and May 2010, 100 patients (Group “Year 2010”) were analyzed retrospectively, who were compared with 76 patients (Group “Year 2008”) from the same period of 2008. Postoperative recovery indexes, complications, and completion rate of fast track items were studied and compared. Results For major fast track items, the completion rates of restrict rehydration, early out-of-bed mobilization, early oral intaking, and management of gastric tube and drains were significantly higher in Group “Year 2010” than those in Group “Year 2008” (Plt;0.05). Meanwhile, the completion rate of urinary catheter management was significantly higher in Group “Year 2008” than that in Group “Year 2010” (Plt;0.05). In early rehabilitation, the first flatus of patients in Group “Year 2010” 〔(3.86±1.05) d〕 was significantly earlier than that in Group “Year 2008” 〔(4.28±1.22) d〕, Plt;0.05; for postoperative hospital stay, though, there was no statistically significant difference between two groups (Pgt;0.05). As to the complications, there was also no statistically significant difference between two groups (Pgt;0.05). Conclusions As the concepts of fast track surgery became increasingly favorable, completion rates of fast track items are increased. As a result, more and more fast track items turn into regular perioperative care. Although enhanced recovery has been achieved, better collaboration and localilzation are still needed to make the full advantage of fast track surgery.
Objective To investigate the application progress of postoperative fluid administration in colorectal surgery. MethodsLiteratures about the advancement of fluid administration in colorectal surgery were reviewed and analyzed. Results Compared to standard fluid management, restrictive fluid administration could reduce the incidence of complications, the length of stay in hospital and improve postoperative survival rate. Colloid-crystalloid combined therapy was better than that pure crystal therapy. Conclusion Volume and type of rehydration influence postoperative recovery, which is also considered in “fast track” colorectal surgery.
Objective To explore the value and clinical safety of low-dose dexamethasone used after operation of anastomotic colorectal resection with fast-track surgery in patients with colorectal cancer. Methods Between January 2008 and December 2009, 470 patients undergoing anastomotic colorectal resection were analyzed retrospectively, who were divided into dexamethasone group and control group according to the use of low-dose dexamethasone treatment or not after operation. Postoperative adverse effect, complications, and early rehabilitations were studied. Results There was no statistical significance in postoperative incidence of adverse effect or complications between two groups (Pgt;0.05). In early rehabilitation, first ambulation of patients in the dexamethasone group was significantly earlier than that in the control group (Plt;0.05), while there was no statistical significance in first time of passing flatus, stool, and oral intake, the retain time of nasogastric tubes, urinary catheter, and drains, and postoperative hospital stay (Pgt;0.05). Conclusion Using low-dose dexamethasone after operation anastomotic colorectal resection in patients with colorectal cancer is safe and may have potential to enhance recovery after operation.
Objective To discuss the feasibility and safety of early oral feeding after colorectal cancer resection and early postoperative recovery condition.Methods Between January 2008 and June 2008, 128 patients diagnosed definitely as colorectal cancer were analyzed retrospectively. Fifty-six cases were treated with early oral feeding (EOF group), and 72 cases were treated with traditional feeding (TF group). The length of postoperative hospital stay, time of first flatus and defecation, and incidences of gastric retention, ileus, severe diarrhea, anastomotic leakage, wound infection, and pulmonary infection were studied and compared. Results The postoperative hospital stay, time of first flatus and defecation in EOF group were apparently shorter than those in TF group (Plt;0.05). As to the incidence of postoperative complications, EOF group had a higher incidence of gastric retention (Plt;0.05), while the differences of incidences of ileus, severe diarrhea, anastomotic leakage, wound infection, and pulmonary infection were not statistically significant between the two groups (Pgt;0.05). Early oral feeding can be tolerated by as much as 89.29% (50/56) patients. Conclusion Early oral feeding after colorectal cancer resection is safe and feasible, and can promote early rehabilitation of patients.
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 (Plt;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 (Plt;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 (Plt;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 (Pgt;0.05). The difference of early recovery and postoperative complications between HAR group and LAR group in fluid restriction group had no statistical significance (Pgt;0.05). Conclusion Different strategies for surgical treatment of rectal cancer patients combined with restrict rehydration in fasttrack is feasible and can promote early rehabilitation of patients.
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 （Plt;0.05）, while there was no significant difference in time of using nasogastric tubes or drains （Pgt;0.05）. There was also no significant difference in postoperative morbidity of complications between the 2 groups （Pgt;0.05）. Conclusion Fast-track surgery for low/super-low rectal cancer is safe and can accelerate recovery with decreased length of hospital stay.
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Objective To explore the content and scientific evidence of every element of the fast-track programmes in colorectal surgery. Methods The literatures about the applied status and opinion of the modality applied in the surgical treatment of the colorectal cancer and fundament investigation in recent years were collected and reviewed. Results The feasibility of the every fast-track’s element was based on the clinical and fundamental investigaton. Conclusion The advantage of the fast-track programmes in colorectal surgery is confirmed.