title: Fast track surgery vs. conventional management in the perioperative care of retroperitoneal laparoscopic adrenalectomy.
abstract: OBJECTIVE
  It has been demonstrated that fast track (FT) surgery can accelerate the recovery of the patients in limited urologic procedures, but there are no reports regarding FT surgery within retroperitoneal laparoscopic adrenalectomy (RLA). This study aims at evaluating the impact of FT surgery on recovery after RLA.
  
  
  METHODS
  One hundred patients in our centre are randomly assigned to FT group and conventional group. The patients who have undergone RLA receive either conventional care or an FT recovery program. Surgical outcome, complications, gastrointestinal function, visual analogue scale (VAS) general state and VAS pain scores are compared between the two groups. In addition, white blood cell count, serum interleukin-6 and C-reactive protein levels are measured. Patients are discharged home when they meet discharge criteria.
  
  
  RESULTS
  Compared with the conventional group, the time of first flatus (18.97±8.45 vs. 37.66±17.17 h), initiation of normal diet (18.76±4.94 vs. 53.15±15.99 h), the time of first ambulation (19.64±6.23 vs. 51.89±18.19 h), length of post-operation hospital stay (2.35±0.87 vs. 5.23±1.62 d), duration of drainage (18.19±5.19 vs. 68.10±18.06 h) and catheter (17.19±4.49 vs. 60.83±25.53 h) are markedly shorter in FT group (P<0.01). Post-operative coughing pain scores at 2 h (1.00±0.61 vs. 1.42±1.18), 12 h (0.96±0.78 vs. 2.00±1.40), 24 h (1.10±0.97 vs. 4.22±1.53) and resting pain scores at 12 h (0.64±0.56 vs. 1.44±0.91), 24 h (0.66±0.63 vs. 1.22±0.86) are consistently lower in the FT group. The level of CRP, IL-6 at 2 h and 24 h post-operation are lower than that of control group, and white blood cell count is lower than conventional group at 24 h after surgery (P<0.01). FT patients have a overall higher level of post-operative VAS general state than conventional groups (P<0.01). Age, sex, tumor size and side, BMI, ASA score, operation time, blood loss and complications are similar in both groups.
  
  
  CONCLUSIONS
  FT surgery within RLA shortens the length of post-operative hospital stay without increasing the postoperative complication, lowers patients' VAS pain scores, and reduces inflammatory response intensity and improves the general state. Therefore, FT can be applied feasibly and safely in RLA.
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Chaopeng
authors.initials: C
authors.lastname: Tang
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Yi
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Haowei
authors.initials: H
authors.lastname: He
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Zhengyu
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Shen
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Yulin
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Wenquan
authors.initials: W
authors.lastname: Zhou
keywords: Fast track surgery; VAS pain scores; perioperative care; retroperitoneal laparoscopic adrenalectomy; urology