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The Impact of Fast-Track Versus Traditional Perioperative Program on the Clinical and Immunological Outcomes After Laparoscopic Colorectal Surgery: a Prospective Randomized Trial
Simon S. NG*1, Wing WA Leung1, Simon K. Chan2, Margaret H. NG3, Tony W. Mak1, Sophie S. Hon1, Dennis Ngo1, Simon Chu1, Cherry Y. Wong1, Janet F. Lee1
1Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong; 2Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong; 3Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Background: Fast-track (FT) perioperative programs have been introduced in the West to reduce surgical stress and enhance recovery after open colorectal surgery. However, few studies have evaluated the impact of FT programs on the outcomes after laparoscopic colorectal surgery.
Aim: To compare the clinical and immunological outcomes of Chinese patients undergoing laparoscopic surgery for colorectal cancer within a FT vs. a traditional perioperative program.
Methods: Between December 2010 and March 2013, 128 consecutive patients who underwent elective laparoscopic surgery for colonic and upper rectal cancer were randomized to receive either FT (n = 64) or traditional perioperative program (n = 64). Primary outcome was total postoperative hospital stay (including hospital stay of patients who were readmitted within 30 days after surgery). Secondary outcomes were 30-day morbidity and readmission rates, immunological parameters, quality of life, and costs. Data were analyzed by intention-to-treat principle.
Results: The overall protocol compliance rate in the FT group was 80%. The FT group had shorter median postoperative hospital stay (4 vs. 5 days; P <0.001) and total postoperative hospital stay (4 vs. 5.5 days; P <0.001) than the traditional group. Overall 30-day morbidity rate also was lower in the FT group (14.1% vs. 28.1%; P = 0.051). Regression analysis revealed that FT program (P <0.001) and absence of complications (P <0.001) were strong independent predictors of shorter total hospital stay. There was no difference in readmission rates between the two groups (6.3% vs. 6.3%; P = 1.000). Quality of life in terms of physical and social functioning was better in the FT group than in the traditional group at 12 weeks after surgery. The total hospital cost was US$12,423 for the FT group and US$14,127 for the traditional group (P = 0.054). Postoperative systemic cytokine response (interleukin-6 peak level) was less in the FT group than in the traditional group. Several lymphocyte subsets of the cell-mediated immune system (total T cells, helper T cells, and natural killer-like T cells) also were less suppressed in the FT group.
Conclusions: FT perioperative program after laparoscopic surgery for colorectal cancer results in faster clinical recovery, reduced morbidity, lower hospital cost, less stress response, and better-preserved cell-mediated immunity compared with traditional perioperative care. FT program is an independent predictor of shorter total postoperative hospital stay after laparoscopic colorectal surgery. (ClinicalTrials.gov number, NCT01341366)
This study was supported by the Health and Health Services Research Fund, Food and Health Bureau, The Government of the Hong Kong SAR (Reference Number 08090061); PI: Professor Simon SM Ng.
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