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Published in: Surgical Endoscopy 9/2011

01-09-2011

Laparoscopy within a fast-track program enhances the short-term results after elective surgery for resectable colorectal cancer

Authors: Francesco Feroci, Katrin C. Kröning, Elisa Lenzi, Luca Moraldi, Stefano Cantafio, Marco Scatizzi

Published in: Surgical Endoscopy | Issue 9/2011

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Abstract

Background

Whether laparoscopic colorectal resection improved recovery within an enhanced recovery program was investigated.

Methods

This study was designed as a query of a prospectively maintained colorectal database to identify 350 patients who underwent elective colorectal resection with primary anastomosis for colorectal cancer between January 1, 2005 and December 31, 2009. Patients were categorized into two groups (laparoscopic and open resection), and demographic, treatment, and outcome variables were independently reviewed for accuracy. A detailed fast-track protocol was prepared and distributed to all patients, department doctors, and nurses to standardize the treatment.

Results

A total of 209 patients underwent laparoscopic-assisted colorectal resection, and 141 had open surgery. There was no difference between the two groups in terms of age, sex, BMI, ASA, comorbidity, previous abdominal surgery, preoperative chemoradiotherapy, cancer site, and AJCC 2002 staging. Twenty-three patients in the laparoscopic group required conversion to an open procedure due to hemorrhage, tumor extension, or technical difficulties. Laparoscopic patients had earlier tolerance of diet, bowel movement, flatus and stool canalization, mobilization, suction drain removal, and interruption of analgesic drug administration. Length of postoperative stay was shorter (4 vs. 7 days, p = 0.0004) and fewer postoperative nonsurgical complications (3 vs. 13% p = 0.009) were registered for the laparoscopic group.

Conclusions

This study suggests that within an enhanced recovery program, laparoscopic resection may provide the best short-term clinical outcomes for patients with resectable colorectal cancer.
Literature
1.
go back to reference Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 345(8952):763–764PubMedCrossRef Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 345(8952):763–764PubMedCrossRef
2.
go back to reference Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24(3):466–477PubMedCrossRef Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24(3):466–477PubMedCrossRef
3.
go back to reference Schwenk W, Raue W, Haase O, Junghans T, Müller JM (2004) “Fast-track” colonic surgery-first experience with a clinical procedure for accelerating postoperative recovery. Chirurg 75(5):508–514PubMedCrossRef Schwenk W, Raue W, Haase O, Junghans T, Müller JM (2004) “Fast-track” colonic surgery-first experience with a clinical procedure for accelerating postoperative recovery. Chirurg 75(5):508–514PubMedCrossRef
4.
go back to reference Wichmann MW, Eben R, Angele MK, Brandenburg F, Goetz AE, Jauch KW (2007) Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study. ANZ J Surg 77(7):502–507PubMedCrossRef Wichmann MW, Eben R, Angele MK, Brandenburg F, Goetz AE, Jauch KW (2007) Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study. ANZ J Surg 77(7):502–507PubMedCrossRef
5.
go back to reference Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928PubMedCrossRef Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928PubMedCrossRef
6.
go back to reference Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA (2006) Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group; Enhanced Recovery after Surgery (ERAS) Group. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809PubMedCrossRef Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA (2006) Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group; Enhanced Recovery after Surgery (ERAS) Group. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809PubMedCrossRef
7.
go back to reference Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872PubMedCrossRef Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872PubMedCrossRef
8.
go back to reference Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90(12):1497–1504PubMedCrossRef Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90(12):1497–1504PubMedCrossRef
9.
go back to reference Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbølle P, Hendel HW, Rosenberg J, Kehlet H (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89(4):446–453PubMedCrossRef Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbølle P, Hendel HW, Rosenberg J, Kehlet H (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89(4):446–453PubMedCrossRef
10.
go back to reference Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46(7):851–859PubMedCrossRef Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46(7):851–859PubMedCrossRef
11.
go back to reference Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92(11):1354–1362PubMedCrossRef Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92(11):1354–1362PubMedCrossRef
12.
go back to reference Jakobsen DH, Sonne E, Andreasen J, Kehlet H (2006) Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis 8(8):683–687PubMedCrossRef Jakobsen DH, Sonne E, Andreasen J, Kehlet H (2006) Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis 8(8):683–687PubMedCrossRef
13.
go back to reference Kehlet H (2005) Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res 165:8–13PubMedCrossRef Kehlet H (2005) Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res 165:8–13PubMedCrossRef
14.
go back to reference Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA (2007) Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 24(6):441–449PubMedCrossRef Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA (2007) Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 24(6):441–449PubMedCrossRef
15.
go back to reference Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46(4):503–509PubMedCrossRef Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46(4):503–509PubMedCrossRef
16.
go back to reference Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138(3):252–256PubMedCrossRef Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138(3):252–256PubMedCrossRef
17.
18.
go back to reference Tinmouth J, Tomlinson G (2004) Laparoscopically assisted versus open colectomy for colon cancer. N Engl J Med 351(9):933–934PubMedCrossRef Tinmouth J, Tomlinson G (2004) Laparoscopically assisted versus open colectomy for colon cancer. N Engl J Med 351(9):933–934PubMedCrossRef
19.
go back to reference Guillou P, Quirke P, Thorpe H, Walker J, Jaine DG, Smith AM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre randomized controlled trial. Lancet 365:1718–1726PubMedCrossRef Guillou P, Quirke P, Thorpe H, Walker J, Jaine DG, Smith AM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre randomized controlled trial. Lancet 365:1718–1726PubMedCrossRef
20.
go back to reference Lacy AM, Garcia-Valdecasas JC, Pique JM, Delgado S, Campo E, Bordas JM (1995) Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9:1101–1105PubMed Lacy AM, Garcia-Valdecasas JC, Pique JM, Delgado S, Campo E, Bordas JM (1995) Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9:1101–1105PubMed
21.
go back to reference The COLOR Study Group (2000) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg 17:617–622CrossRef The COLOR Study Group (2000) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg 17:617–622CrossRef
22.
go back to reference King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93(3):300–308PubMedCrossRef King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93(3):300–308PubMedCrossRef
23.
go back to reference Basse L, Jakobsen DH, Bardram L, Billesbølle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241(3):416–423PubMedCrossRef Basse L, Jakobsen DH, Bardram L, Billesbølle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241(3):416–423PubMedCrossRef
24.
go back to reference Scatizzi M, Kröning KC, Boddi V, De Prizio M, Feroci F (2010) Fast-track surgery after laparoscopic colorectal surgery: is it feasible in a general surgery unit? Surgery 147(2):219–226PubMedCrossRef Scatizzi M, Kröning KC, Boddi V, De Prizio M, Feroci F (2010) Fast-track surgery after laparoscopic colorectal surgery: is it feasible in a general surgery unit? Surgery 147(2):219–226PubMedCrossRef
25.
go back to reference Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–277PubMedCrossRef Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–277PubMedCrossRef
26.
go back to reference Kehlet H, Büchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202(1):45–54PubMedCrossRef Kehlet H, Büchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202(1):45–54PubMedCrossRef
27.
go back to reference MacKay G, Ihedioha U, McConnachie A, Serpell M, Molloy RG, O’Dwyer PJ (2007) Laparoscopic colonic resection in fast-track patients does not enhance short-term recovery after elective surgery. Colorectal Dis 9(4):368–372PubMedCrossRef MacKay G, Ihedioha U, McConnachie A, Serpell M, Molloy RG, O’Dwyer PJ (2007) Laparoscopic colonic resection in fast-track patients does not enhance short-term recovery after elective surgery. Colorectal Dis 9(4):368–372PubMedCrossRef
Metadata
Title
Laparoscopy within a fast-track program enhances the short-term results after elective surgery for resectable colorectal cancer
Authors
Francesco Feroci
Katrin C. Kröning
Elisa Lenzi
Luca Moraldi
Stefano Cantafio
Marco Scatizzi
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 9/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1643-z

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