A Prospective Single Center Experience of "Fast-Track" in Colorectal Surgery: Toward Zero Anastomotic Complications
Pierluigi Di Sebastiano*, Nicola Mastrodonato, Giovanni Bisceglia, Beniamino Rucci, Antonio Cafaro, Antonio De Bonis, Angelo Ambrosio, Matteo Scaramuzzi, Vincenzo Crucinio, Fabio Francesco Di Mola, Giuseppe Mascetta, Matteo Tardio
Department of Surgery, IRCCS casa Sollievo Sofferenza, San Giovanni Rotondo, Italy
The present study report a prospective observational single center experience of a multimodal perioperative management protocol (fast-track) in patients undergoing elective colorectal resection for cancer.We aimed to explore whether fast-track surgery can be safely applied and improve the outcomes of patients undergoing elective colorectal resection for cancer.
Methods: In December 2006 we started a fast-track protocol for patients with colorectal cancer. Since dec. 2006 to nov. 2007 we performed 252 colorectal procedures. Perioperative data from 90 consecutive patients (Group 1) who underwent elective R0 colorectal resection by means of fast-track surgery in a high-volume medical center were analysed and compared with 109 previously performed consecutive elective R0 resections out of 369 colorectal operations (group 2, nov 2005-nov 2006) and treated before the beginning with our fast-track management protocol. Fast-track patients received intravenous fluid restriction, early oral intake and prokinetic agents, early mobilisation and fixed pain treatment by mean of continuous elastomeric pump. Patients belonging to group 2 received conventional fluid administration to prevent oliguria, restricted oral intake until return of bowel motility and conventional analgesia. Endpoints were postoperative complications, postoperative stay and mortality.
Results: Of the 90 patients of group 1, 73 received a colon resection, 17 a total mesorectal excision for rectal cancer. Of the 109 patients of group 2, 83 received a colon resection, 26 a total mesorectal excision for rectal cancer. Patients in the group 2 required a longer median postoperative stay of 2 days (10 vs. 8). Patients of group 1 had significantly lesser medical and surgical complications, first of all in terms of respiratory distress (1.2% vs. 2%). In addition, we observed zero anastomotic leakage vs. 5% in group 2. There were 2 deaths in patients belonging to group 2 vs. 1 death in group 1.
Conclusions: Our data confirm that fast-track surgery is feasible in colorectal surgery and demonstrate that a multimodal management protocol is safe and able to significantly reduce postoperative stay and morbidity.
