Colorectal Disease ª 2013 The Association of Coloproctology of Great Britain and Ireland. 16, 134–140
TITULO Y AUTORES:
A multicentre comparison of a fast track or conventional postoperative protocol following laparoscopic or open elective surgery for colorectal cancer surgery
F. Esteban*, F. J. Cerdan*, M. Garcia-Alonso*, R. Sanz-Lopez*, A. Arroyo†, J. M. Ramirez‡, C. Moreno§, R. Morales¶, A. Navarro** and M. Fuentes**Hospital Clinico San Carlos, Madrid, Spain, †Hospital Universitario Elche, Alicante, Spain, ‡Hospital Clinico Universitario Zaragoza, Zaragoza, Spain, §Hospital La Mancha Centro, Alcazar de San Juan, Ciudad Real, Spain, ¶Hospital Son Llatzer, Palma de Mallorca, Spain and **Hospital Universitario Mutua Terrassa,Terrassa, Barcelona, Spain
Received 30 January 2013; accepted 29 August 2013; Accepted Article online 25 October 2013
Aim The introduction of multimodal or fast track (FT) rehabilitation and laparoscopy in colorectal
surgery has improved patient recovery and shortened hospital stay (HS). This study aimed to determine the influence
of laparoscopic or open surgery on the postoperative recovery of colorectal cancer patients having a conven- tional care
(CC) or FT protocol in the postoperative period.
Method A multicentre prospective study was controlled with a retrospective group.
The prospective group included 300 patients having elective colorectal resec- tion for cancer.
The retrospective control group included 201 patients with the same characteristics who were treated before the
introduction of the programme. The patients were divided into four groups including laparoscopy + FT, open surgery + FT,
laparoscopy + CC, and open surgery + CC. The primary end-points were HS and morbidity. Secondary end-points included mortality
and reoperation rates.
Results The overall median HS was 7 days. The median HS for laparoscopy + FT was 5 days,
open + FT 6 days, laparoscopy + CC 9 days and open + CC 10 days (P < 0.001). In the regression model the laparoscopy + FT group had the greatest reduction in HS (P < 0.001). A significant reduction in HS was observed in the laparoscopy + FT group compared with laparoscopy + CC (P < 0.001). The overall patient mor- bidity was 30.6%. The logistic regression model adjusted for propensity score showed no statistically sig- nificant differences between the study groups regarding all other end-points.
Conclusion Colorectal cancer patients who underwent laparoscopic surgery within a multimodal
rehabilitation protocol experienced the shortest HS and the lowest morbidity.
Keywords Laparoscopy, enhanced recovery, fast track, colorectal surgery
What does this paper add to the literature?
This is the first multicentre study of the Spanish Working Group on Fast Track Surgery which aimed
to determine the effect of laparoscopic or open surgery on patient recovery in a fast track programme.
The results show that laparoscopy with fast track manage- ment resulted in les morbidity and a shorter hospital stay.