title: Implementation of fast-track protocols in open and laparoscopic sphincter-preserving rectal cancer surgery: a multicenter, comparative, prospective, non-randomized study.
abstract: BACKGROUND
  Data on the role of laparoscopy within an enhanced recovery protocol for rectal cancer patients is rather limited. The aim of the study was to investigate the role of laparoscopy within a 'fast-track' protocol in patients who underwent sphincter-preserving surgery for rectal cancer.
  
  
  METHODS
  156 consecutive patients with low rectal cancer from three centers were assigned in four groups: the open fast track (OPEN-FT), the laparoscopic fast track (LAP-FT), the open (OPEN), and the laparoscopic (LAP). The fast-track protocol was applied in one center and traditional care in the other two. All patients underwent sphincter-preserving surgery and were followed-up for 30 days.
  
  
  RESULTS
  Overall morbidity was less in the fast-track groups (p = 0.007). On the other hand, no statistical significance could be identified in mortality, readmission or reoperations rates among the groups (p = 0.562, p = 0.896, p = 0.238). Fast-track patients required significantly less intramuscular opioids for postoperative analgesia (p < 0.001). Primary (p < 0.001) and total hospital stays (p < 0.001) were significantly shorter in the fast-track groups.
  
  
  CONCLUSIONS
  The implementation of a fast-track protocol is feasible and safe in low rectal cancer patients. Laparoscopy seems to be a basic element of such protocol as it further enhances recovery and reduces morbidity.
authors.affiliation: First Department of General Surgery, Agia Olga Hospital, Athens, Greece. nikos.gouvas@gmail.com
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Gouvas
authors.forename: George
authors.initials: G
authors.lastname: Gogos-Pappas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsimogiannis
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Tsimoyiannis
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Xynos
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D003082:Colectomy / Q000379:methods; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome