Safety of Fast Track Surgery for Patients with Obstructive Colorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HAO Jin ^1,2,3 , YANG Tinghan ^1,2,4 , PU Yi ^1,2,4 , YANG Guangchao ^1,2,4 , WANG Xiaodong ^1,2 ,  LI Li ^1,2

1.Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China Hospital MCQ Team, Sichuan University, Chengdu 610041, China;;
3.West China College of Stomatology, Sichuan University, Chengdu 610041, China;;
4.West China Medical School, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Li, Email: drlili116@126.com

Keywords：

Colorectal cancer; Intestinal obstruction; Fast track; Safety

Video：

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Objective To discuss the safety of fast track surgery for patients with obstructive colorectal cancer. Methods Between February 2008 and February 2009, 157 cases of obstructive colorectal cancer were analyzed retrospectively, 59 in fast track (FT) group and 98 in traditional group. Postoperative early rehabilitations and complications were studied and compared. Results The first time of passing flatus, oral intake and postoperative hospital stay in FT group were significantly earlier or less than those in traditional group （P lt;0.05）, while there were no significant differences in time of first ambulation, time with use of nasogastric tubes, urinary catheter, and drains between the 2 groups （P gt;0.05）. There was also no statistically significant difference in postoperative complications rate between the 2 groups （P gt;0.05）. Conclusion Fast track surgery for patients with obstructive colorectal cancer is safe and can accelerate recovery with decreasing length of hospital stay and improving life quality of the patients.

Citation： HAO Jin ,YANG Tinghan,PU Yi,YANG Guangchao,WANG Xiaodong,LI Li. Safety of Fast Track Surgery for Patients with Obstructive Colorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(12): 1314-1317. doi: Copy

1.	Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
2.	Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793.
3.	汪晓东, 谢尧, 肖军, 等. 快速流程在结直肠外科手术后管理中的应用 [J]. 中国普通外科杂志, 2008； 17（4）: 394-396.
4.	李立, 汪晓东, 舒晔, 等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南 [J]. 中国普外基础与临床杂志, 2009; 16(5-8): 413, 493-494, 581, 671.
5.	赖玮婧, 汪晓东, 陈海燕, 等. 梗阻型中下段直肠癌一期吻合手术的临床效果 [J]. 中国普外基础与临床杂志, 2009； 16（11）: 918-921.
6.	Basse L, Thorbl JE, Lssl K, et al. Colonic surgery with accelerated rehabilitation or conventional care [J]. Dis Colon Rectum, 2004; 47(3): 271-277.
7.	Isbister WH, Al-Sanea N. POSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [J]． ANZ J Surg, 2002; 72(6): 421-425.
8.	Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 45-54.
9.	罗超兰, 杨向东．直肠癌的手术治疗进展 [J]．结直肠肛门外科, 2008； 14(1): 72-74．.
10.	王振军, 马华崇．直肠癌合并急性肠梗阻的外科处理策略 [J]．中国实用外科杂志, 2007； 27(6): 455-457．.
11.	彭爱国, 金小顺, 赵怀辉．结肠癌并发急性肠梗阻的外科治疗 [J]．安徽医学, 2010； 31(6): 610-611．.
12.	de Aguilar-Nascimento JE, Caporossi C, Nascimento M. Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon [J]. Arq Gastroenterol, 2002; 39(4): 240-245．.
13.	Durán Giménez-Rico H, Abril Vega C, Herreros Rodríguez J, et al． Hartmann’s procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery [J]． Clin Transl Oncol, 2005; 7(7): 306-313.
14.	Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon [J]． Am J Surg, 2005; 189(4): 384-387.
15.	Omejc M, Stor Z, Jelenc F, et al． Outcome after emergency subtotal/total colectomy compared to elective resection in patients with left-sided colorectal carcinoma [J]． Int Surg, 1998; 83(3): 241-244.
16.	黄勇, 陈志棠. 结、直肠癌并发急性肠梗阻的外科治疗 [J]. 国际医药卫生导报, 2007； 13（1）: 22-23.
17.	Vukovic＇ M, Moljevic＇ N. Total colectomy-options in management of acute obstruction of the left-side colon [J]． Med Pregl, 2008; 61(1-2): 43-47.
18.	汪晓东, 赖玮婧, 肖凌, 等. 结直肠外科术前快速肠道准备研究进展 [J]. 结直肠肛门外科, 2009； 15（5）: 365-368.
19.	Hasenberg T, Keese M, Lngle F, et al. ‘Fast-track’ colonic surgery in Austria and Germany-results from the survey on patterns in current perioperative practice [J]. Colorectal Dis, 2009; 11(2): 162-167.
20.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466-477.
21.	Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695.
22.	Fleshman JW, Fry RD, Birnbaum EH, et al. Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcome [J]. Dis Colon Rectum, 1996; 39(1): 15-22.
23.	Hsu TC. Feasibility of colectomy with mini-incision [J]. Am J Surg, 2005; 190(1): 48-50.
24.	周寅, 杨廷翰, 汪晓东, 等. 早期经口进食在结直肠癌术后快速流程模式中的应用 [J]. 中国普外基础与临床杂志, 2010； 17(5)： 500-503.
25.	杨廷翰, 周寅, 余曦, 等. 低位/超低位直肠癌快速流程模式的效果探讨 [J]. 中国普外基础与临床杂志, 2010； 17(6)： 618-621.
26.	Husted H, Hansen HC, Holm G, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark [J]. Arch Orthop Trauma Surg, 2010; 130(2): 263-268.
27.	Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971-975.
28.	肖凌, 李蔚, 麦玲, 等. 快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响 [J]. 中国普外基础与临床杂志, 2010； 17(2): 190-194.
29.	刘展, 汪晓东, 李立. 多学科协作诊治模式下的结直肠外科快速康复流程 [J]. 中国普外基础与临床杂志, 2007； 14(2)： 239-242.

1. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
2. Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793.
3. 汪晓东, 谢尧, 肖军, 等. 快速流程在结直肠外科手术后管理中的应用 [J]. 中国普通外科杂志, 2008； 17（4）: 394-396.
4. 李立, 汪晓东, 舒晔, 等. 四川大学华西医院肛肠外科·结直肠外科快速流程临床指南 [J]. 中国普外基础与临床杂志, 2009; 16(5-8): 413, 493-494, 581, 671.
5. 赖玮婧, 汪晓东, 陈海燕, 等. 梗阻型中下段直肠癌一期吻合手术的临床效果 [J]. 中国普外基础与临床杂志, 2009； 16（11）: 918-921.
6. Basse L, Thorbl JE, Lssl K, et al. Colonic surgery with accelerated rehabilitation or conventional care [J]. Dis Colon Rectum, 2004; 47(3): 271-277.
7. Isbister WH, Al-Sanea N. POSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [J]． ANZ J Surg, 2002; 72(6): 421-425.
8. Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 45-54.
9. 罗超兰, 杨向东．直肠癌的手术治疗进展 [J]．结直肠肛门外科, 2008； 14(1): 72-74．.
10. 王振军, 马华崇．直肠癌合并急性肠梗阻的外科处理策略 [J]．中国实用外科杂志, 2007； 27(6): 455-457．.
11. 彭爱国, 金小顺, 赵怀辉．结肠癌并发急性肠梗阻的外科治疗 [J]．安徽医学, 2010； 31(6): 610-611．.
12. de Aguilar-Nascimento JE, Caporossi C, Nascimento M. Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon [J]. Arq Gastroenterol, 2002; 39(4): 240-245．.
13. Durán Giménez-Rico H, Abril Vega C, Herreros Rodríguez J, et al． Hartmann’s procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery [J]． Clin Transl Oncol, 2005; 7(7): 306-313.
14. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon [J]． Am J Surg, 2005; 189(4): 384-387.
15. Omejc M, Stor Z, Jelenc F, et al． Outcome after emergency subtotal/total colectomy compared to elective resection in patients with left-sided colorectal carcinoma [J]． Int Surg, 1998; 83(3): 241-244.
16. 黄勇, 陈志棠. 结、直肠癌并发急性肠梗阻的外科治疗 [J]. 国际医药卫生导报, 2007； 13（1）: 22-23.
17. Vukovic＇ M, Moljevic＇ N. Total colectomy-options in management of acute obstruction of the left-side colon [J]． Med Pregl, 2008; 61(1-2): 43-47.
18. 汪晓东, 赖玮婧, 肖凌, 等. 结直肠外科术前快速肠道准备研究进展 [J]. 结直肠肛门外科, 2009； 15（5）: 365-368.
19. Hasenberg T, Keese M, Lngle F, et al. ‘Fast-track’ colonic surgery in Austria and Germany-results from the survey on patterns in current perioperative practice [J]. Colorectal Dis, 2009; 11(2): 162-167.
20. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466-477.
21. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695.
22. Fleshman JW, Fry RD, Birnbaum EH, et al. Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcome [J]. Dis Colon Rectum, 1996; 39(1): 15-22.
23. Hsu TC. Feasibility of colectomy with mini-incision [J]. Am J Surg, 2005; 190(1): 48-50.
24. 周寅, 杨廷翰, 汪晓东, 等. 早期经口进食在结直肠癌术后快速流程模式中的应用 [J]. 中国普外基础与临床杂志, 2010； 17(5)： 500-503.
25. 杨廷翰, 周寅, 余曦, 等. 低位/超低位直肠癌快速流程模式的效果探讨 [J]. 中国普外基础与临床杂志, 2010； 17(6)： 618-621.
26. Husted H, Hansen HC, Holm G, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark [J]. Arch Orthop Trauma Surg, 2010; 130(2): 263-268.
27. Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971-975.
28. 肖凌, 李蔚, 麦玲, 等. 快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响 [J]. 中国普外基础与临床杂志, 2010； 17(2): 190-194.
29. 刘展, 汪晓东, 李立. 多学科协作诊治模式下的结直肠外科快速康复流程 [J]. 中国普外基础与临床杂志, 2007； 14(2)： 239-242.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety of Fast Track Surgery for Patients with Obstructive Colorectal Cancer

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