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 (Plt;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 (Plt;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 (Plt;0.05), while there was no significant difference in general complications and surgical complications between two groups (Pgt;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.
Objective To discuss the feasibility and safety of early oral feeding after colorectal cancer resection and early postoperative recovery condition.Methods Between January 2008 and June 2008, 128 patients diagnosed definitely as colorectal cancer were analyzed retrospectively. Fifty-six cases were treated with early oral feeding (EOF group), and 72 cases were treated with traditional feeding (TF group). The length of postoperative hospital stay, time of first flatus and defecation, and incidences of gastric retention, ileus, severe diarrhea, anastomotic leakage, wound infection, and pulmonary infection were studied and compared. Results The postoperative hospital stay, time of first flatus and defecation in EOF group were apparently shorter than those in TF group (Plt;0.05). As to the incidence of postoperative complications, EOF group had a higher incidence of gastric retention (Plt;0.05), while the differences of incidences of ileus, severe diarrhea, anastomotic leakage, wound infection, and pulmonary infection were not statistically significant between the two groups (Pgt;0.05). Early oral feeding can be tolerated by as much as 89.29% (50/56) patients. Conclusion Early oral feeding after colorectal cancer resection is safe and feasible, and can promote early rehabilitation of patients.
Objective To compare the short-term outcomes between laparoscopic surgery and open surgery with fast-track (FT) in patients with colorectal cancer. Methods Between February 2008 and August 2008, the clinical data of 177 patients with colorectal cancer were analyzed retrospectively, who were divided into open group (n=122) and laparoscopic group (n=55) by surgery methods. Open group was further divided into FT group (n=66) and traditional group (n=56). Early rehabilitations were studied and compared among three groups. Results ① The baseline characteristics of patients among three groups were no significant differences (Pgt;0.05) exclude operation time. ② In early rehabilitation, the first flatus of patients in both the FT group 〔(3.86±1.01) d〕 and the laparoscopic group 〔(3.78±1.10) d〕 was significantly earlier than that in the traditional group 〔(4.43±1.25) d〕, Plt;0.05. ③ The first oral intaking in the FT group 〔(2.52±1.14) d〕 was earlier than that in the traditional group 〔(3.38±1.43) d〕 and the laparoscopic group 〔(5.04±2.24) d〕, Plt;0.05, while in the traditional group was earlier than that in the laparoscopic group (Plt;0.05). ④ For drainage management, both the FT group and the traditional group were significantly earlier than those in the laparoscopic group (Plt;0.05). ⑤ For postoperative hospital stay, in the FT group 〔(8.33±1.98) d〕 was also much shorter than that in the laparoscopic group 〔(10.55±3.14) d〕 and the traditional group 〔(10.82±3.76) d〕, Plt;0.05. ⑥ For the postoperative complications, there was no significant difference among three groups (Pgt;0.05). Conclusions FT surgery and laparoscopic technique could both enhance recovery of bowel function, and FT could also shorten postoperative hospital stay. However, further studies are needed to develop a better management.
Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.
Objective To investigate the impact of complete video-assisted thoracoscopic lobectomy and open lobectomy on perioperative heart rate （HR） and blood oxygen saturation （SO2） of lung cancer patients，and explore whether minimally invasive surgery can enhance postoperative recovery of lung cancer patients. Methods A total of 138 lung cancer patients were chosen from 161 consecutive patients with pulmonary diseases who were admitted to West China Hospital of Sichuan University between September 2010 and December 2011. According to different surgical approach，all the 138 lung cancer patients were divided into routine thoracotomy group （thoracotomy group，70 patients including 53 males and 17 females with their average age of 56.1±9.7 years） and complete video-assisted thoracoscopic lobectomy group （VATS group，68 patients including 46 males and 22 females with their average age of 53.4±6.5 years）. There was no statistical difference in preoperative clinical characteristics between the 2 groups. Preoperative and postoperative （1st，3rd，7th and 30th day） numeric pain rating scale （NPRS），HR and SO2 were compared between the 2 groups. Results （1） There was no statistical difference in NPRS on the 1st and 3rd postoperative day between the 2 groups （3.83±0.79 vs. 3.93±0.67， 2.88±0.59 vs. 3.03±0.71，P＞0.05），but on the 7th and 30th postoperative day，NPRS of the thoracotomy group was signi- ficantly higher than that of VAST group （1.61±0.33 vs. 1.22±0.12，1.58±0.26 vs. 1.19±0.31，P＜0.05）. （2） Postop- erative sedentary HR of both VATS group and thoracotomy group were significantly higher than preoperative levels ［（84.13±17.21） / minute vs. （73.67±10.32）/minute， （86.13 ±19.67） / minute vs. （72.24±14.21） / minute， P＜0.05］. Postoperative HR of VATS group decreased to preoperative level on the 3rd postoperative day，while postoperative HR of the thoracotomy group decreased to preoperative level on the 7th postoperative day. （3） There was no statistical difference between preoperative and postoperative （all the time points） sedentary SO2 of both VATS group and thoracotomy group （96.34 %±2.11% vs. 97.12%±2.31%，95.33%±4.13% vs. 94.93% ±4.31%，P＞0.05）.（4） The changes of HR and SO2 before and after exercise of VATS group were significantly smaller than those of the thoracotomy group on the 3rd postoperative day ［（11.11±4.81）/minute vs. （18.23±6.17）/minute，3.1%±1.2% vs. 7.4 %±2.7%，P＜0.05］ . Conclusion The impact of complete video-assisted thoracoscopic lobectomy on cardiopulmonary function is comparatively smaller，which is helpful for postoperative fast-track recovery of lung cancer patients.
ObjectiveTo explore the role of fast-track surgery (FTS) in day-case laparoscopic cholecystectomy (DLC) pain management. MethodsWe used bidirectional cohort study to investigate the patients undergoing day surgery of laparoscopic cholecystectomy admitted into our department. A total of 143 patients between April and September 2014 receiving routine pain management were chosen to be the control group, and 78 patients between October 2014 and January 2015 receiving FTS pain management were regarded as the FTS group. Postoperative pain, early ambulation, influence of pain on the sleep, patients' satisfaction and prolonged hospital stay rate were compared between the two groups. ResultsPain scores of patients in the FTS group 0-0.5, 0.5-6, 6-12, and 12-24 hours after surgery were significantly lower than those in the control group (P<0.05). The proportion of patients with early postoperative ambulation and patients' satisfaction rate in the FTS group were significantly higher than the control group (P<0.05). ConclusionThe FTS pain management model can effectively reduce patients' pain after DLC, accelerate patients' postoperative rehabilitation and increase patients' satisfaction.
Objective To discuss the clinical outcome of fast-track surgery for low/super-low rectal cancer. Methods Between October 2007 and December 2008, 120 patients underwent low/super-low rectal cancer resection without formation of stoma in the West China Hospital were analyzed retrospectively. Postoperative early rehabilitations were compared between fast-track group and traditional group. Results In early rehabilitations, time of first passing flatus, ambulation, oral intake, and pulling out urinary catheter and the hospital stay in fast-track group were significantly earlier than those in traditional group （Plt;0.05）, while there was no significant difference in time of using nasogastric tubes or drains （Pgt;0.05）. There was also no significant difference in postoperative morbidity of complications between the 2 groups （Pgt;0.05）. Conclusion Fast-track surgery for low/super-low rectal cancer is safe and can accelerate recovery with decreased length of hospital stay.
Objective To explore the variation about the application of fast-track surgery and laparoscopy in treatment for colorectal cancer in recent years． To investigate the probability of combining protocols of the two for treatment for colorectal cancer. Methods The clinical and basic literatures of related researches about colorectal treatment of laparoscopy and fast-track surgery were collected and reviewed. Results Compared with the traditional treatment modalities, both of fast-track surgery and laparoscopy used for the treatment of colorectal cancer have better clinical effects. Conclusions Fast-track surgery and laparoscopic techniques used for the treatment of colorectal cancer are feasible, but the combination of the two should be confirmed by further randomized controlled trials.
Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
Objective To evaluate the effect of perioperative period clinical care mode through fast-track (FT) under nonminimal invasive operation on the inflammatory response of colorectal cancer resection. Methods Fifty-five patients underwent elective colorectal cancer resection were randomized divided into two groups: FT group (n=29) in which patients were performed FT perioperative care and tradition group (n=26) in which patients were received traditional perioperative care. The nonminimal invasive operations were performed in this study. The venous blood samples were respectively collected at 24 h before operation, at 24 h, 72 h, and 7 d after operation, and were used to detect the concentrations of serum C-reactive protein (CRP) and serum amyloid A protein (SAA).Results There was no complication such as infection, fistula of stoma and inflammatory ileus that was potential to influence the study results in two groups, and no patient died. The trend of changes in the concentrations of CRP and SAA of patients was accordant in each group. The peak concentrations of CRP and SAA of patients in FT group were respectively observed at 24 h after operation 〔CRP: (72.36±60.94) mg/L; SAA: (328.97±267.20) mg/L〕, while which were respectively delayed to 72 h after operation in tradition group 〔CRP: (112.71±63.92) mg/L; SAA: (524.18±331.03) mg/L〕. At the same time, the concentrations of CRP and SAA in FT group began to descend 〔CRP: (57.21±30.42) mg/L; SAA: (237.43±215.66) mg/L〕. The peak concentrations of CRP and SAA in tradition group were significantly higher than that in FT group (Plt;0.001) and the concentrations of CRP and SAA in FT group were significantly lower than those in tradition group at 72 h after operation (Plt;0.001). On 7 d after operation, the concentrations of CRP and SAA further decreased, but the difference between two groups was not significant (Pgt;0.05). Likewise, the concentrations of CRP and SAA at 7 d after operation were significant higher than those 24 h and 72 h after operation (Plt;0.001), lower than that 24 h before operation (Plt;0.001), respectively. Conclusion This study demonstrates that perioperative period clinical care mode through FT under non-minimal invasive operation can reduce the inflammatory response of colorectal carcinoma resections and scientific clinical care is an important means to promote quick rehabilitation.