title: Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study).
abstract: OBJECTIVE
  To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer.
  
  
  BACKGROUND
  Important developments in elective colorectal surgery are the introduction of laparoscopy and implementation of FT care, both focusing on faster recovery.
  
  
  METHODS
  In a 9-center trial, patients eligible for segmental colectomy were randomized to laparoscopic or open colectomy, and to FT or standard care, resulting in 4 treatment groups. Primary outcome was total postoperative hospital stay (THS). Secondary outcomes were postoperative hospital stay (PHS), morbidity, reoperation rate, readmission rate, in-hospital mortality, quality of life at 2 and 4 weeks, patient satisfaction and in-hospital costs. Four hundred patients were required to find a minimum difference of 1 day in hospital stay.
  
  
  RESULTS
  Median THS in the laparoscopic/FT group was 5 (interquar-tile range: 4-8) days; open/FT 7 (5-11) days; laparoscopic/standard 6 (4.5-9.5) days, and open/standard 7 (6-13) days (P < 0.001). Median PHS in the laparoscopic/FT group was 5 (4-7) days; open/FT 6 (4.5-10) days; laparoscopic/standard 6 (4-8.5) days and open/standard 7 (6-10.5) days (P < 0.001). Secondary outcomes did not differ significantly among the groups. Regression analysis showed that laparoscopy was the only independent predictive factor to reduce hospital stay and morbidity.
  
  
  CONCLUSIONS
  Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program. If open surgery is applied, it is preferentially done in FT care. This study was registered under NTR222 (www.trialregister.nl).
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Malaika S
authors: MS
authors: Vlug
authors: Jan
authors: J
authors: Wind
authors: Markus W
authors: MW
authors: Hollmann
authors: Dirk T
authors: DT
authors: Ubbink
authors: Huib A
authors: HA
authors: Cense
authors: Alexander F
authors: AF
authors: Engel
authors: Michael F
authors: MF
authors: Gerhards
authors: Bart A
authors: BA
authors: van Wagensveld
authors: Edwin S
authors: ES
authors: van der Zaag
authors: Anna A W
authors: AA
authors: van Geloven
authors: Mirjam A G
authors: MA
authors: Sprangers
authors: Miguel A
authors: MA
authors: Cuesta
authors: Willem A
authors: WA
authors: Bemelman