Accelerated enhanced Recover y following M inimally I nvasive colorectal cancer surgery ( RecoverMI ): a study protocol for a novel randomised controlled trial

Abstract

IntroductionDefinitive treatment of localised colorectal cancer involves surgical resection of the primary tumour. Short-stay colectomies (eg, 23-hours) would have important implications for optimising the efficiency of inpatient care with reduced resource utilisation while improving the overall recovery experience with earlier return to normalcy. It could permit surgical treatment of colorectal cancer in a wider variety of settings, including hospital-based ambulatory surgery environments. While a few studies have shown that discharge within the first 24 hours after minimally invasive colectomy is possible, the safety, feasibility and patient acceptability of a protocol for short-stay colectomy for colorectal cancer have not previously been evaluated in a prospective randomised study. Moreover, given the potential for some patients to experience a delay in recovery of bowel function after colectomy, close outpatient monitoring may be necessary to ensure safe implementation.Methods and analysisIn order to address this gap, we propose a prospective randomised trial of accelerated enhanced Recovery following Minimally Invasive colorectal cancer surgery (RecoverMI) that leverages the combination of minimally invasive surgery with enhanced recovery protocols and early coordinated outpatient remote televideo conferencing technology (TeleRecovery) to improve postoperative patien-provider communication, enhance postoperative treatment navigation and optimise postdischarge care. We hypothesise that RecoverMI can be safely incorporated into multidisciplinary practice to improve patient outcomes and reduce the overall 30-day duration of hospitalisation while preserving the quality of the patient experience.Ethics and disseminationRecoverMI has received institutional review board approval and funding from the American Society of Colorectal Surgeons (ASCRS; LPG103). Results from RecoverMI will be published in a peer-reviewed publication and be used to inform a multisite trial.Trial registration numberNCT02613728; Pre-results.

Predictive Factors of Health Discharge Outcomes for Colorectal Cancer Patients in a Romanian Hospital

“…However, the facilities that want to facilitate earlier discharge need to uptake short-stay protocols. (16) In the literature, higher hospital volume, as in our case, was associated with a length of stay reduction. It was found that a longer length of stay is associated with an increased risk of 30-day readmission.…”

Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial)

“…This study was approved by the Institutional Review Board at the University of Texas MD Anderson Cancer Center (MDACC), and registered with http://clinicaltrials.gov (NCT02613728). Details of the trial design have been published previously.…”

“…Patients with endoscopically unresectable polyps requiring surgical management were also eligible. The planned surgical resection had to be performed by laparoscopic or robotic surgery, and the surgeon had to plan for primary anastomosis without creation of an ostomy. Patients were approached at their preoperative clinic visit regarding participation in the study.…”

“…Patients with a serum creatinine level above 1·5 ng/ml, measured within 30 days of surgery, or a history of congestive heart failure, defined as ejection fraction of 40 per cent or less, or of more than 40 per cent with associated systemic signs of heart failure, were also excluded. Finally, any patients requiring conversion to open surgery or in whom an ostomy was necessary at completion of surgery were removed from the study and not randomized.…”

“…Details of the interventions used in the trial have been described previously. Briefly, all patients enrolled in the study had standardized preadmission, preoperative and intraoperative care, including mechanical bowel preparation with oral antibiotics, narcotic‐sparing anaesthesia, goal‐directed fluid management and MIS (laparoscopic or robotic).…”