Impact of fast-track care program in laparoscopic rectal cancer surgery: a cohort-comparative study.
Compliance
Enhanced recovery after surgery
Rectal cancer
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
14
03
2021
accepted:
17
10
2021
pubmed:
6
4
2022
medline:
7
6
2022
entrez:
5
4
2022
Statut:
ppublish
Résumé
Fast-track care programs after surgery improve recovery and decrease the length of hospital stay and postoperative morbidity in colonic cancer. However, the true impact of these programs on morbidity rates after rectal cancer surgery remains unclear. We aimed to assess the feasibility and impact of the fast-track program on postoperative outcomes after restorative laparoscopic rectal cancer resection and temporary loop ileostomy. This single-center observational study assessed data of patients undergoing elective rectal cancer surgery during a defined period before (standard group) and after the introduction of a fast-track program (fast-track group) from a prospectively maintained database. The primary endpoint was postoperative 90-day morbidity. Secondary endpoints were 30-day morbidity, fast-track program compliance, length of hospital stay, and readmission rate. Overall, 336 patients (n = 176, standard group; n = 160, fast-track group) were assessed; there was no significant between-group difference in the patients' baseline characteristics (age, sex, body mass index, comorbidities, or neoadjuvant treatment). The protocol compliance rate was 91.4% in the fast-track group. The 90-day morbidity and mean total length of hospital stay were significantly lower in the fast-track group than in the standard group (34% vs 49%, respectively, p < 0.01 and 8.96 days vs 10.2 days, p < 0.01, respectively). There was no difference in readmission rates. Multivariate analysis revealed the fast-track program to be the only predictive factor of postoperative morbidity. Fast-track programs can be safely implemented following rectal cancer surgery to reduce the overall morbidity rate and length of hospital stay without adversely increasing the readmission rate.
Sections du résumé
BACKGROUND
Fast-track care programs after surgery improve recovery and decrease the length of hospital stay and postoperative morbidity in colonic cancer. However, the true impact of these programs on morbidity rates after rectal cancer surgery remains unclear. We aimed to assess the feasibility and impact of the fast-track program on postoperative outcomes after restorative laparoscopic rectal cancer resection and temporary loop ileostomy.
METHODS
This single-center observational study assessed data of patients undergoing elective rectal cancer surgery during a defined period before (standard group) and after the introduction of a fast-track program (fast-track group) from a prospectively maintained database. The primary endpoint was postoperative 90-day morbidity. Secondary endpoints were 30-day morbidity, fast-track program compliance, length of hospital stay, and readmission rate.
RESULTS
Overall, 336 patients (n = 176, standard group; n = 160, fast-track group) were assessed; there was no significant between-group difference in the patients' baseline characteristics (age, sex, body mass index, comorbidities, or neoadjuvant treatment). The protocol compliance rate was 91.4% in the fast-track group. The 90-day morbidity and mean total length of hospital stay were significantly lower in the fast-track group than in the standard group (34% vs 49%, respectively, p < 0.01 and 8.96 days vs 10.2 days, p < 0.01, respectively). There was no difference in readmission rates. Multivariate analysis revealed the fast-track program to be the only predictive factor of postoperative morbidity.
CONCLUSION
Fast-track programs can be safely implemented following rectal cancer surgery to reduce the overall morbidity rate and length of hospital stay without adversely increasing the readmission rate.
Identifiants
pubmed: 35378628
doi: 10.1007/s00464-021-08811-5
pii: 10.1007/s00464-021-08811-5
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
4712-4720Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
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 90:1497–1504. https://doi.org/10.1002/bjs.4371
doi: 10.1002/bjs.4371
pubmed: 14648727
Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007635
doi: 10.1002/14651858.CD007635
pubmed: 21328298
Chen CC, Huang IP, Liu MC, Jian JJ, Cheng SH (2011) Is it appropriate to apply the enhanced recovery program to patients undergoing laparoscopic rectal surgery? Surg Endosc 25:1477–1483. https://doi.org/10.1007/s00464-010-1417-z
doi: 10.1007/s00464-010-1417-z
pubmed: 21052724
Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal optimization of surgical care in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872. https://doi.org/10.1097/01.sla.0000259219.08209.36
doi: 10.1097/01.sla.0000259219.08209.36
pubmed: 17522511
pmcid: 1876970
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 46:851–859. https://doi.org/10.1007/s10350-004-6672-4
doi: 10.1007/s10350-004-6672-4
pubmed: 12847356
Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X (2012) Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis 14:1009–1013. https://doi.org/10.1111/j.1463-1318.2011.02855.x
doi: 10.1111/j.1463-1318.2011.02855.x
pubmed: 21985126
Branagan G, Richardson L, Shetty A, Chave HS (2010) An enhanced recovery programme reduces length of stay after rectal surgery. Int J Colorectal Dis 25:1359–1362. https://doi.org/10.1007/s00384-010-1032-4
doi: 10.1007/s00384-010-1032-4
pubmed: 20714738
Maggiori L, Rullier E, Lefevre JH et al (2017) Does a combination of laparoscopic approach and full fast track multimodal management decrease postoperative morbidity?: a multicenter randomized controlled trial. Ann Surg 266:729–737. https://doi.org/10.1097/SLA.0000000000002394
doi: 10.1097/SLA.0000000000002394
pubmed: 28806303
Keane C, Savage S, McFarlane K, Seigne R, Robertson G, Eglinton T (2012) Enhanced recovery after surgery versus conventional care in colonic and rectal surgery. ANZ J Surg 82:697–703. https://doi.org/10.1111/j.1445-2197.2012.06139.x
doi: 10.1111/j.1445-2197.2012.06139.x
pubmed: 22882553
Chung KC, Lee KC, Chen HH, Cheng KC, Wu KL, Song LC (2020) Differential short-term outcomes of laparoscopic resection in colon and rectal cancer patients aged 80 and older: an analysis of nationwide inpatient sample. Surg Endosc. https://doi.org/10.1007/s00464-020-07459-x
doi: 10.1007/s00464-020-07459-x
pubmed: 32989550
Emmanuel A, Chohda E, Lapa C, Miles A, Haji A, Ellul J (2018) Defunctioning stomas result in significantly more short-term complications following low anterior resection for rectal cancer. World J Surg 42:3755–3764. https://doi.org/10.1007/s00268-018-4672-0
doi: 10.1007/s00268-018-4672-0
pubmed: 29777268
pmcid: 6182750
Gustafsson UO, Scott MJ, Schwenk W, Enhanced Recovery After Surgery Society, European Society for clinical Nutrition and Metabolism (ESPEN), International Association for Surgical Metabolism and Nutrition et al (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg 37:259–284. https://doi.org/10.1007/s00268-012-1772-0
doi: 10.1007/s00268-012-1772-0
pubmed: 23052794
Nygren J, Thacker J, Carli F et al (2013) Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg 37:285–305. https://doi.org/10.1007/s00268-012-1787-6
doi: 10.1007/s00268-012-1787-6
pubmed: 23052796
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Colwell JC, Kupsick PT, Mc Nichol LL (2016) Outcome criteria for discharging the patient with a new ostomy from home health care: a WOCN society consensus conference. J Wound Ostomy Cont Nurs 43:269–273. https://doi.org/10.1097/WON.0000000000000230
doi: 10.1097/WON.0000000000000230
Feng F, Li XH, Shi H et al (2014) Fast-track surgery combined with laparoscopy could improve postoperative recovery of low-risk rectal cancer patients: a randomized controlled clinical trial. J Dig Dis 15:306–313. https://doi.org/10.1111/1751-2980.12142
doi: 10.1111/1751-2980.12142
pubmed: 24597608
Lee SM, Kang SB, Jang JH, Park JS, Hong S, Lee TG, Ahn S (2013) Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial. Surg Endosc 27:3902–3909. https://doi.org/10.1007/s00464-013-3006-4
doi: 10.1007/s00464-013-3006-4
pubmed: 23708720
Huibers CJ, de Roos MA, Ong KH (2012) The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis 27:751–757. https://doi.org/10.1007/s00384-011-1385-3
doi: 10.1007/s00384-011-1385-3
pubmed: 22173714
Teeuwen PH, Bleichrodt RP, de Jong PJ, van Goor H, Bremers AJ (2011) Enhanced recovery after surgery versus conventional perioperative care in rectal surgery. Dis Colon Rectum 54:833–839. https://doi.org/10.1007/DCR.0b013e318216067d
doi: 10.1007/DCR.0b013e318216067d
pubmed: 21654250
Stottmeier S, Harling H, Wille-Jørgensen P, Balleby L, Kehlet H (2012) Postoperative morbidity after fast-track laparoscopic resection of rectal cancer. Colorectal Dis 14:769–775. https://doi.org/10.1111/j.1463-1318.2011.02767.x
doi: 10.1111/j.1463-1318.2011.02767.x
pubmed: 21848895
Meillat H, Brun C, Zemmour C et al (2020) Laparoscopy is not enough: full ERAS compliance is the key to improvement of short-term outcomes after colectomy for cancer. Surg Endosc 34:2067–2075. https://doi.org/10.1007/s00464-019-06987-5
doi: 10.1007/s00464-019-06987-5
pubmed: 31385073
Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J, Enhanced Recovery After Surgery Study Group (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–7. https://doi.org/10.1007/s00268-016-3460-y
doi: 10.1007/s00268-016-3460-y
pubmed: 21242424
Khreiss W, Huebner M, Cima RR et al (2014) Improving conventional recovery with enhanced recovery in minimally invasive surgery for rectal cancer. Dis Colon Rectum 57:557–563. https://doi.org/10.1097/DCR.0000000000000101
doi: 10.1097/DCR.0000000000000101
pubmed: 24819094
Mohan HM, Pasquali A, O’Neill B, Collins D, Winter DC (2019) Stoma rods in abdominal surgery: a systematic review and metaanalyses. Tech Coloproctol 23:201–206. https://doi.org/10.1007/s10151-019-01935-w
doi: 10.1007/s10151-019-01935-w
pubmed: 30806842
Denost Q, Rouanet P, Faucheron JL et al (2017) To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer: the GRECCAR 5 randomized trial. Ann Surg 265:474–480. https://doi.org/10.1097/SLA.0000000000001991
doi: 10.1097/SLA.0000000000001991
pubmed: 27631776