Randomized Controlled Study of Fast-Track Surgery for Elderly Patients with Colorectal Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Tinghan ^1,2,3 , PU Yi ^1,2,3 , ZHAO Na ^1,2,3 , ZHANG Wanhua ^1,2,3 , WANG Xiaodong ^1,2 , LI Li ^1,2

1.Department 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 Medical School, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Fast-track surgery; Colorectal cancer; Elderly; Prospective study

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To discuss the feasibility and clinical outcomes of fast-track (FT) surgery for elderly patients (≥70 years) with colorectal carcinoma.
Methods Between November 2007 and January 2009, 103 elderly patients were analyzed prospectively, who were divided into FT group and traditional group randomly. All 103 patients had completed the entire study. Postoperative complications and early rehabilitations were studied and compared. In addition, completion of FT courses was recorded.
Results ① In early rehabilitation, the time of first ambulation was (1.96±0.89) d and (2.92±1.43) d, oral intaking was (2.41±0.92) d and (3.62±1.40) d, and first flatus was (3.88±1.05) d and (4.52±1.29) d in the FT group and the traditional group, respectively. The early rehabilitation indexes in the FT group were significantly earlier than those in the traditional group (P lt;0.05). ② Postoperative hospital stay was (9.27±1.87) d and (12.75±7.05) d in the FT group and the traditional group, respectively, in the FT group which was shorter than that in the traditional group (P lt;0.05). ③ The mortality rate and readmission rate was 0 on 2 weeks after operation in two groups. ④ The total morbidity rate was 11.76% (6/51) in the FT group, in the traditional group was 28.85% (15/52), there was significant difference between two groups (P lt;0.05), while there was no significant difference in general complications and surgical complications between two groups (P gt;0.05).
Conclusions FT surgery for elderly patients with colorectal carcinoma is feasible and could enhance recovery, cut down morbidity rate and shorten postoperative hospital stay. If the FT courses are more completed, the clinical outcomes could be better.

Citation： YANG Tinghan ,PU Yi,ZHAO Na,ZHANG Wanhua,WANG Xiaodong,LI Li. Randomized Controlled Study of Fast-Track Surgery for Elderly Patients with Colorectal Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 983-988. doi: Copy

1.	Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
2.	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): 611615.
3.	Scharfenberg M, Raue W, Junghans T, et al. “Fasttrack” rehabilitation after colonic surgery in elderly patients-is it feasible? [J]. Int J Colorectal Dis, 2007; 22(12): 14691474.
4.	Bardram L, FunchJensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection [J]. Br J Surg, 2000; 87(11): 15401545.
5.	Tsikitis VL, Holubar SD, Dozois EJ, et al. Advantages of fasttrack recovery after laparoscopic right hemicolectomy for colon cancer [J]. Surg Endosc, 2010; 24(8): 19111916.
6.	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（一） [J]. 中国普外基础与临床杂志， 2009; 16(5): 413.
7.	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（二） [J]. 中国普外基础与临床杂志， 2009; 16(6): 493494.
8.	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（三） [J]. 中国普外基础与临床杂志， 2009; 16(7): 581.
9.	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（四） [J]. 中国普外基础与临床杂志， 2009; 16(8): 671.
10.	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.
11.	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.
12.	吕东吴，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志， 2007; 14(6): 713715.
13.	Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 19211928.
14.	Basse L, Hjort Jakobsen D, Billesblle P, et al. A clinical pathway to accelerate recovery after colonic resection [J]. Ann Surg, 2000; 232(1): 5157.
15.	King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300308.
16.	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.
17.	Marusch F, Koch A, Schmidt U, et al. The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management [J]. World J Surg, 2005; 29(8): 10131021.
18.	刘展，杨廷翰，余曦，等. 快速流程围手术期临床管理降低结直肠癌手术炎性反应的随机临床研究 [J]. 中国普外基础与临床杂志， 2010; 17(8): 858863.
19.	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.
20.	Hsu TC. Feasibility of colectomy with miniincision [J]. Am J Surg, 2005; 190(1): 4850.
21.	李立. 结直肠癌外科应用技术的规范与创新（一） [J]. 中国普外基础与临床杂志， 2006; 13(1): 106109.
22.	Nakagoe T, Sawai T, Tsuji T, et al. Early outcome after minilaparotomy for the treatment of rectal cancer [J]. Eur J Surg, 2001; 167(9): 705710.
23.	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.
24.	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.
25.	Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690695.

1. Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
2. 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): 611615.
3. Scharfenberg M, Raue W, Junghans T, et al. “Fasttrack” rehabilitation after colonic surgery in elderly patients-is it feasible? [J]. Int J Colorectal Dis, 2007; 22(12): 14691474.
4. Bardram L, FunchJensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection [J]. Br J Surg, 2000; 87(11): 15401545.
5. Tsikitis VL, Holubar SD, Dozois EJ, et al. Advantages of fasttrack recovery after laparoscopic right hemicolectomy for colon cancer [J]. Surg Endosc, 2010; 24(8): 19111916.
6. 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（一） [J]. 中国普外基础与临床杂志， 2009; 16(5): 413.
7. 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（二） [J]. 中国普外基础与临床杂志， 2009; 16(6): 493494.
8. 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（三） [J]. 中国普外基础与临床杂志， 2009; 16(7): 581.
9. 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（四） [J]. 中国普外基础与临床杂志， 2009; 16(8): 671.
10. 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.
11. 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.
12. 吕东吴，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志， 2007; 14(6): 713715.
13. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 19211928.
14. Basse L, Hjort Jakobsen D, Billesblle P, et al. A clinical pathway to accelerate recovery after colonic resection [J]. Ann Surg, 2000; 232(1): 5157.
15. King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300308.
16. 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.
17. Marusch F, Koch A, Schmidt U, et al. The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management [J]. World J Surg, 2005; 29(8): 10131021.
18. 刘展，杨廷翰，余曦，等. 快速流程围手术期临床管理降低结直肠癌手术炎性反应的随机临床研究 [J]. 中国普外基础与临床杂志， 2010; 17(8): 858863.
19. 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.
20. Hsu TC. Feasibility of colectomy with miniincision [J]. Am J Surg, 2005; 190(1): 4850.
21. 李立. 结直肠癌外科应用技术的规范与创新（一） [J]. 中国普外基础与临床杂志， 2006; 13(1): 106109.
22. Nakagoe T, Sawai T, Tsuji T, et al. Early outcome after minilaparotomy for the treatment of rectal cancer [J]. Eur J Surg, 2001; 167(9): 705710.
23. 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.
24. 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.
25. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690695.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Randomized Controlled Study of Fast-Track Surgery for Elderly Patients with Colorectal Carcinoma

Abstract Full text Figures/Tables Video References Cited by

Format

Content