title: Fast-track versus standard care in laparoscopic high anterior resection: a prospective randomized-controlled trial.
abstract: The value of fast-track (FT) multimodal recovery programs in improving hospitalization of surgical patients has been widely proved. The application of FT protocols to laparoscopic colorectal surgery seems to maximize the effects of the minimally invasive approach. The objectives of this randomized-controlled trial are to compare the short-term outcomes (bowel function, return to oral nutrition, day of discharge, fatigue, time to resume normal activities, functional capabilities, and readmission rate) of patients undergoing elective laparoscopic high anterior resection (HAR) following either a FT or a standard program. The prospective randomized-controlled trial included 52 consecutive patients undergoing elective laparoscopic HAR. Group 1 was treated with a FT rehabilitation program, and group 2 was treated with a standard care (SC) program. Patients were interviewed 14 and 30 days postoperatively. One patient in each group was excluded from the study. Mean hospital stay, time of first bowel movement, and bowel function resumption were significantly shorter in the FT group (P<0.05). Patients in the FT group referred more pain in day 0 versus patients in the SC group (P<0.05) even though the difference disappeared from day 1. Fatigue was significantly reduced at day 14 in the FT group compared with the SC group (P<0.01). Similarly, ability to resume the normal preoperative attitude (walking stairs, cooking, housekeeping, shopping, and walking outdoors) was significantly better at day 14 in the FT group (P<0.005). There was no significant difference between the 2 groups at day 30 for the same parameters. There were no readmissions in both the groups and no need for consultations from general practitioners. FT multimodal program is a safe approach effective on postoperative short-term outcome significantly reducing hospital stay. Early postoperative pain control needs to be optimized.
authors.affiliation: Chirurgia Generale e Videolaparoscopica. Ospedale Niguarda-Cà Granda, Milano, Italy.
authors.forename: Giulio M
authors.initials: GM
authors.lastname: Mari
authors.forename: Andrea
authors.initials: A
authors.lastname: Costanzi
authors.forename: Dario
authors.initials: D
authors.lastname: Maggioni
authors.forename: Matteo
authors.initials: M
authors.lastname: Origi
authors.forename: Giovanni C
authors.initials: GC
authors.lastname: Ferrari
authors.forename: Paolo
authors.initials: P
authors.lastname: De Martini
authors.forename: Stefano
authors.initials: S
authors.lastname: De Carli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pugliese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods* / Q000534:rehabilitation; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome