Fast-track Surgery Applied In Colorectal Surgery

The concept of fast-track surgery(FTS) was first proposed by the Danishsurgeon Kehlet. He focuses on the use of various measures which are provedeffective to control patients’ perioperative pathological and physiology reaction,in the hope of reducing surgical stress and complications, enhancingpostoperative rehabilitation and improving the prognosis. In essence, FTS canbe interpreted as a multimodal perioperative care. The concept is mainlyconsisting of simplified bowel preparation, no routine mechanical enema,epidural anesthesia and analgesia, laparoscopic surgery, early removal ofnasogastric tube and drainage tubes, early postoperative eating and exercise. Inrecent years, this concept has been gradually accepted by the western contries,and formed a new perioperative management mode. In the review part,according to some randomized controlled trials and meta-analysis, the absenceof routine mechanical enema, epidural anesthesia and analgesia, early removalof the drainage tube and early postoperative eating, which are majorcomponents of FTS, didn’t cause higer incidence of colorectal surgerycomplications, such as anastomotic fistula, postoperative intestinal obstruction,celiac infection etc. Surprisingly, they can, in some level, shorten patients’ stayin hospital, accelerate the postoperative recovery of bowel function, reduce theinsulin resistance and protect the immune system. The application of FTSconcept in colorectal surgery is safe and effective. However, when it comes toour mainland, FTS fails to find its place in the clinical practice. On one hand,the reason may be the convention of intestinal surgery, which has guided us forhundreds of years. On the other hand, it may be due to the doubt holded bydoctors. Because those randomized controlled trials and meta-analysismentioned above are mostly based on patients of Europe and America. As a result, our doctors can’t be certain whether these conclusions are suitable forChinese. This study give an analysis of70cases of patients with colorectalcancer, whom are addimitted to the Gastric and Colorectal Surgery Departmentof the First Hospital of Jilin University during January2010to July2011.Objective: to evaluate the effect of FTS applying in colorectal cancersurgery, and to provide some reference for the domestic popularize of FTSconcept in clinical practice.Materials and Methods: according to different perioperative treatments,70patients, undergoing elective laparoscopic surgery for colorectal cancer, aredivided into two groups, one is the FT group (shortened fasting time, no oralantibiotics before surgery, no mechanical enema, early remoal of urinarycatheter and drainage tubes, early postoperative eating and exercise) consists of31cases, and the other is the traditional control group, including39cases.Record these two groups’ length of stay in hospital, flatulence and defecatetime, days before tolereating normal diet, use of analgesics, value of C-reactiveprotein(CRP), complication incidence and the expenses etc. index. Then usesoftware to do statistics analysis.Results: the index of age, sex, basis disease proportion, tumor TNM stage,operation, operative duration and amount of blood loss in two groups indicateno difference with statistically significant (P>0.05). FT group has earlyerflatulence time (2.58±1.12d) than the control group (3.13±1.03d)(P <0.05).FT group is also better than the control group in defecate time (4.29±1.95dversus5.15±1.29d, P <0.05). Besides, days before tolereating normal dietdiffer significantly (P <0.05) between FT group (3.39±1.26d) and controlgroup (4.54±1.23d). The preoperative CRP value of FT group(1.42±0.87mg/L)is almost the same as that of Control group(1.43±0.90mg/L)(P>0.05). But theCRP value of FT group on the first day after operation(35.41±7.54mg/L) isobviously lower than that of Control group(40.62±11.93mg/L)(P＜0.05). In the aspects of stay length in hospital, expenses, use of analgesics andcomplications incidence, no obvious difference is demonstrated between thesetwo groups (P>0.05).Conclusion: the application of FTS in colorectal surgery is not only safe,but also effective.