Is it appropriate to apply the enhanced recovery program to patients undergoing laparoscopic rectal surgery?
BACKGROUND
The laparoscopic approach has played a key role in the successful application of the enhanced recovery program (ERP) in perioperative care for postoperative colon surgery patients. Reports of applying ERP in laparoscopic rectal surgery are rare, and the feasibility of doing so has yet to be solidly evaluated. The goal of this study was to evaluate whether it is appropriate to use ERP on patients who undergo rectal surgery via the laparoscopic approach and to further investigate potential factors that may affect the results of this practice modality.


METHODS
Between December 2007 and July 2009, 80 eligible patients (35 women) with a median age of 60 (range, 28-82) years were enrolled. All patients received elective laparoscopic rectal surgery due to malignant or benign rectal lesions. Forty-nine percent of patients received preoperative neoadjuvant chemoradiotherapy (CCRT), because their clinical stage was beyond T3N0 or TanyN(+). The ERP used in this study was modified from a similar protocol used for patients receiving laparoscopic colectomy at the same institution.


RESULTS
Sixty-five percent of patients in the study received a sphincter-preserving procedure, whereas 15 other patients underwent abdominoperineal resection (APR). The median operative time was 160 min. The conversion rate of laparoscopic surgery was 7.5%, and the combined intraoperative and postoperative complication rate was 13.8%. Forty-two patients (52.5% of the study pool) received complete postoperative recovery courses as prescribed by ERP.


CONCLUSIONS
Our preliminary results of applying ERP to patients receiving laparoscopic rectal surgery showed a success rate of 52.5%. The failure of ERP among these patients was related to low rectal lesion locations (below 7 cm AAV) and surgery-related complications. ERP for laparoscopic rectal surgery is feasible but is not advised for all cases requiring laparoscopic rectal surgery.
Department of Surgery, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan. peter70.chen@msa.hinet.net
Chien-Chih
CC
Chen
I-Ping
IP
Huang
Mei-Ching
MC
Liu
James Jer-Min
JJ
Jian
Skye Hon-Chun
SH
Cheng
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003289:Convalescence; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D019990:Perioperative Care; D011183:Postoperative Complications / Q000628:therapy; D011300:Preoperative Care; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*