title: Open sphincter-preserving surgery of extraperitoneal rectal cancer without primary stoma and Fast Track Protocol.
abstract: OBJECTIVE
  Fast track protocol (FTP) showed to improve perioperative care. The study aims to evaluate the impact of the FTP in the open extraperitoneal rectal cancer (ERC) surgical treatment without a primary derivative stoma (DS) and the QoL in patients with or without a secondary DS.
  
  
  METHODS
  50 patients affected by ERC were enrolled and operated on with open low anterior resection without a primary DS. They were randomized in two groups: one was treated perioperativelly in the traditional way (group T), the other using a modif ed FTP (group FT). A QoL questionnaire was administered prior to discharge and at 1-month follow-up.
  
  
  RESULTS
  Five courses (10%) were complicated by anastomotic leakage: 3 (12%) in the FT group (2 minor and 1 maior) and 2 (8%) in the T group (1 minor and 1 maior) (p=n.s.). All the maiors and one minor were treated with a DS. Patients of the group FTP were considered dischargeable earlier that those of group T (p<0.05). Patients with DS had a significantly lower QoL score (p<0.0001).
  
  
  CONCLUSIONS
  FTP with minor modifications is feasible and safe in the ERC open surgery without using a DS. Better results were obtained without increasing complication rate. A secondary DS impacts detrimentally on QoL.
authors.forename: G
authors.initials: G
authors.lastname: Pappalardo
authors.forename: S
authors.initials: S
authors.lastname: Coiro
authors.forename: F
authors.initials: F
authors.lastname: De Lucia
authors.forename: A
authors.initials: A
authors.lastname: Giannella
authors.forename: F
authors.initials: F
authors.lastname: Ruffolo
authors.forename: F M
authors.initials: FM
authors.lastname: Frattaroli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D002985:Clinical Protocols; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D013997:Time Factors