Skip to main content

Advertisement

Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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):763–764

    Article  PubMed  CAS  Google Scholar 

  2. 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):466–477

    Article  PubMed  CAS  Google Scholar 

  3. 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):508–514

    Article  PubMed  CAS  Google Scholar 

  4. 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):502–507

    Article  PubMed  Google Scholar 

  5. Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928

    Article  PubMed  Google Scholar 

  6. 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 93:800–809

    Article  PubMed  CAS  Google Scholar 

  7. 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 245:867–872

    Article  PubMed  Google Scholar 

  8. 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):1497–1504

    Article  PubMed  CAS  Google Scholar 

  9. 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):446–453

    Article  PubMed  CAS  Google Scholar 

  10. 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):851–859

    Article  PubMed  Google Scholar 

  11. 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):1354–1362

    Article  PubMed  CAS  Google Scholar 

  12. Jakobsen DH, Sonne E, Andreasen J, Kehlet H (2006) Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis 8(8):683–687

    Article  PubMed  CAS  Google Scholar 

  13. Kehlet H (2005) Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res 165:8–13

    Article  PubMed  Google Scholar 

  14. 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):441–449

    Article  PubMed  Google Scholar 

  15. 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):503–509

    Article  PubMed  Google Scholar 

  16. Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138(3):252–256

    Article  PubMed  Google Scholar 

  17. Schlinkert RT (1991) Laparoscopic-assisted right hemicolectomy. Dis Colon Rectum 34:1030–1031

    Article  PubMed  CAS  Google Scholar 

  18. Tinmouth J, Tomlinson G (2004) Laparoscopically assisted versus open colectomy for colon cancer. N Engl J Med 351(9):933–934

    Article  PubMed  CAS  Google Scholar 

  19. 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 365:1718–1726

    Article  PubMed  Google Scholar 

  20. 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 9:1101–1105

    PubMed  CAS  Google Scholar 

  21. The COLOR Study Group (2000) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg 17:617–622

    Article  Google Scholar 

  22. 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):300–308

    Article  PubMed  CAS  Google Scholar 

  23. 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):416–423

    Article  PubMed  Google Scholar 

  24. 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):219–226

    Article  PubMed  Google Scholar 

  25. Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–277

    Article  PubMed  Google Scholar 

  26. 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):45–54

    Article  PubMed  Google Scholar 

  27. 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):368–372

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

Drs. Marco Scatizzi, Katrin C. Kröning, Elisa Lenzi, Stefano Cantafio, Luca Moraldi, and Francesco Feroci have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Francesco Feroci.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feroci, F., Kröning, K.C., Lenzi, E. et al. Laparoscopy within a fast-track program enhances the short-term results after elective surgery for resectable colorectal cancer. Surg Endosc 25, 2919–2925 (2011). https://doi.org/10.1007/s00464-011-1643-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1643-z

Keywords

Navigation