Assessment of Enhanced Recovery after Surgery in Elective Colorectal Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 JIANGHua ¹ , LIYun-tao ² , LIUYan-jun ² ,  LIUZhan ²

1. Department of Anesthesiology, The Third People's Hospital of Chengdu City; Affiliated hospital of Southwest Jiaotong University; The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610031, Sichuan Province, China;
2. Department of General Surgery, The Third People's Hospital of Chengdu City; Affiliated hospital of Southwest Jiaotong University; The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610031, Sichuan Province, China;

Corresponding author：

LIUZhan, Email: 1486743796@qq.com

Keywords：

Enhanced recovery after surgery; Colorectal surgery; Anesthesia

DOI：

10.7507/1007-9424.20160264

Video：

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Objective To assess impact of typical parameters recommended by enhanced recovery after surgery (ERAS) program in elective colorectal surgery, and provide some recommendations for surgeon and anesthesiologist. Method The published articles about ERAS program in elective colorectal surgery in recent years were searched in these databases(EMBASE, PubMed, Cochrane Library, Ovid), the impact of each parameter was evaluated basing on hospital stay and rate of postoperative complications. Results After analyzing the literatures, the parameters, which were applied in current rehabilitation programs and covered the pre-, intraand post-operative periods in colorectal surgery, were identified as potential impacting consequences of colorectal surgery. Strong agreements were obtained for the following recommendations:① Preoperative management:bowel preparation, fasting, preanesthetic medication, and nutritional care.② Intraoperative management:fluid management, preventing hypothermia, method of surgery and incision, drugs usages of antibiotics, glucocorticoid and prevention of postoperative nausea and vomiting.③ Postoperative management:managements of drainage tube, nasogastric intubation and urinary catheter, postoperative analgesia, prevention of thromboembolism, and measures of intestinal function recovery (including early mobilization, feeding and chew gum). Conclusion Use of a series of effective measures in ERAS has an effective result, could reduce surgical stress and complications, enhance recovery, shorten hospital stay.

Citation： JIANGHua, LIYun-tao, LIUYan-jun, LIUZhan. Assessment of Enhanced Recovery after Surgery in Elective Colorectal Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(8): 1011-1017. doi: 10.7507/1007-9424.20160264 Copy

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2.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5):606-617.
3.	Kehlet H. Fast-track colorectal surgery. Lancet, 2008, 371(9615):791-793.
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1. Alfonsi P, Slim K, Chauvin M, et al. French guidelines for enhanced recovery after elective colorectal surgery. J Visc Surg, 2014, 151(1):65-79.
2. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5):606-617.
3. Kehlet H. Fast-track colorectal surgery. Lancet, 2008, 371(9615):791-793.
4. Wick C, Shore AD, Hirose K, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum, 2011, 54(12):1475-1479.
5. Kehlet h, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet, 2003, 362(9399):1921-1928.
6. 易文城, 罗琪.快速康复理念在结直肠外科的临床应用探讨.福建医科大学, 2012.
7. 郜永顺, 段小伟, 张云飞, 等.结直肠癌手术中快速康复外科理念的应用价值.郑州大学学报:医学版, 2011, 46(4):593-596.
8. Maessen J, Dejong CH, Hausel J, et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg, 2007, 94(2):224-231.
9. Chilton SN, Burton JP, Reid G. Inclusion of fermented foods in food guides around the world. Nutrients, 2015, 7(1):390-404.
10. Van Hylckama Vlieg JE, Veiga P, Zhang C, et al. Impact of microbial transformation of food on health-form fermented foods to fermentation in the gastro-intestinal tract. Curr Opin Biotechnol, 2011, 22(2):211-219.
11. Slim K, Vicaut E, Launay-Savary MV, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg, 2009, 249(2):203-209.
12. Bretagnol F, Panis Y, Rullier E, et al. Rectal cancer surgery with or without bowel preparation:The French GRECCAR Ⅲ multicenter single-blinded randomized trial. Ann Surg, 2010, 252(5):863-868.
13. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev, 2003, (4):CD004423.
14. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children:guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol, 2011, 28(8):556-569.
15. Wang ZG, Wang Q, Wang WJ, et al. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg, 2010, 97(3):317-327.
16. Mathur S, Plank LD, McCall JL, et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg, 2010, 97(4):485-494.
17. Kaska M, Grosmanová T, Havel E, et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery-a randomized controlled trial. Wien Klin Wochenschr, 2010, 122(1-2):23-30.
18. Noblett SE, Watson DS, Huong H, et al. Pre-operative oral carbohydrate loading in colorectal surgery:a randomized controlled trial. Colorectal Dis, 2006, 8(7):563-569.
19. Maurice-Szamburski A, Auquier P, Viarre-Oreal V, et al. Effect of sedative premedication on patient experience after general anesthesia: a randomized clinical trial. JAMA, 2015, 313(9):916-925.
20. 安广权, 赵雪莲, 高英超, 等.糖预处理法对大肠癌患者术后胰岛素抵抗和血清肿瘤坏死因子受体含量的影响.中华医学杂志, 2008, 88(29):2041-2044.
21. Braga M, Gianotti L, Radaelli G, et al. Perioperative immunonutrition in patients undergoing cancer surgery:results of a randomized double-blind phase 3 trial. Arch Surg, 1999, 134(4):428-433.
22. Smedley F, Bowling T, James M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg, 2004, 91(8):983-990.
23. Finco C, Magnanini P, Sarzo G, et al. Prospective randomized study on perioperative enteral immunonutrition in laparoscopic colorectal surgery. Surg Endosc, 2007, 21(7):1175-1179.
24. Braga M, Gianotti L, Vignali A, et al. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery, 2002, 132(5):805-814.
25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg, 2009, 96(4):331-341.
26. Varadhan KK, Lobo DN. A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery:getting the balance right. Proc Nutr Soc, 2010, 69(4):448-498.
27. Corcoran T, Rhodes JE, Clarke S, et al. Perioperative fluid management strategies in major surgery:a stratified meta-analysis. Anesth Analg, 2012, 114(3):640-651.
28. Srinivasa S, Taylor MH, Sammour T, et al. Oesophageal Doppler-guided fluid administration in colorectal surgery:critical appraisal of published clinical trials. Acta Anaesthesiol Scand, 2011, 55(1):4-13.
29. Bundgaard-Nielsen M, Holte K, Secher NH, et al. Monitoring of peri-operative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand, 2007, 51(3):331-340.
30. Srinivasa S, Kahokehr AA, Yu TC, et al. Preoperative glucocorticoid use in major abdominal surgery:systematic review and meta-analysis of randomized trials. Ann Surg, 2011, 254(2):183-191.
31. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med, 1996, 334(19):1209-1215.
32. Moine P, Fish DN. Pharmacodynamic modelling of intravenous antibiotic prophylaxis in elective colorectal surgery. Int J Antimicrob Agents, 2013, 41(2):167-173.
33. Barclay KL, Zhu YY, Tacey MA. Nausea, vomiting and return of bowel function after colorectal surgery. ANZ J Surg, 2015, 85(11):823-828.
34. Sammour T, Kahokehr A, Chan S, et al. The humoral response after laparoscopic versus open colorectal surgery:a meta-analysis. J Surg Res, 2010, 164(1):28-37.
35. Tang CL, Eu KW, Tai BC, et al. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg, 2001, 88(6):801-807.
36. Pascual M, Alonso S, Parés D, et al. Randomized clinical trial comparing inflammatory and angiogenic response after open versus laparoscopic curative resection for colonic cancer. Br J Surg, 2011, 98(1):50-59.
37. Tsimogiannis KE, Tellis CC, Tselepis AD, et al. Toll-like receptors in the inflammatory response during open and laparoscopic colectomy for colorectal cancer. Surg Endosc, 2011, 26(2):330-336.
38. Veenhof AA, Vlug MS, van der Pas MH, et al. Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care:a randomized trial. Ann Surg, 2012, 255(2):216-221.
39. Gustafsson UO, Tiefenthal M, Thorell A, et al. Laparoscopic-assisted and open high anterior resection within an ERAS protocol. World J Surg, 2012, 36(5):1154-1161.
40. Siddiqui MR, Sajid MS, Qureshi S, et al. Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery:a meta-analysis. Am J Surg, 2010, 200(1):144-161.
41. Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery:a randomized clinical trial (LAFA-study). Ann Surg, 2011, 254(6):868-875.
42. Seiler CM, Deckert A, Diener MK, et al. Midline versus transverse incision in major abdominal surgery:a randomized, double-blind equivalence trial (POVATI:ISRCTN60734227). Ann Surg, 2009, 249(6):913-920.
43. Rao W, Zhang X, Zhang J, et al. The role of nasogastric tube in decompression after elective colon and rectum surgery:a meta-analysis. Int J Colorectal Dis, 2011, 26(4):423-429.
44. Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg, 2005, 92(6):673-680.
45. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev, 2007, (3):CD004929.
46. Mutter D, Panis Y, Escat J. Drainage in digestive surgery. French Society of Digestive Surgery. J Chir (Paris), 1999, 136(3):117-123.
47. Launay-Savary MV, Slim K. Evidence-based analysis of prophylactic abdominal drainage. Ann Chir, 2006, 131(5):302-305.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Assessment of Enhanced Recovery after Surgery in Elective Colorectal Surgery

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