Fast-track surgery versus conventional perioperative management of lung cancer-associated pneumonectomy: a randomized controlled clinical trial

Abstract

BackgroundThe aim of this study is to investigate the effects of fast-track surgery (FTS) on postoperative recovery, hospital stay, total medical costs, and the complications of pneumonectomy in patients with non-small cell lung cancer (NSCLC).MethodsStudies were performed between June 2012 and March 2014 in 17 patients received FTS and 18 patients given conventional management (control) after pneumonectomy in the Department of Thoracic Surgery, the Fourth Affiliated Hospital of Harbin Medical University. Patients were evaluated based on their days to achieve the first postoperative flatus, C-reactive protein (CRP) at postoperative day (POD) 1–7, the length of hospital stay, the medical costs, and postoperative complications.ResultsThe results showed that in the FTS group, latency to the first postoperative flatus (1.5 ± 0.6 versus 3.1 ± 0.8 s in controls, P < 0.0001), CRP (71.36 ± 5.48 versus 80.71 ± 8.32 mg/L in at POD 7, P < 0.0001), the length of hospital stay (18.1 ± 1.4 versus 27.4 ± 6.6 days, P < 0.0001), and the medical costs (29.9 ± 2.7 versus 37.2 ± 3.6 thousand Chinese Yuan, P < 0.0001) were significantly reduced compared to the group receiving conventional management. FTS group also had a relatively lower postoperative complication rate (23.5% of 17 versus 33.3% of 18 in control group) although it was statistically insignificant (P = 0.711).ConclusionsThese results indicate that application of the FTS in NSCLC pneumonectomy efficiently accelerates postoperative recovery, shortens hospital stay, reduces the total medical costs of the patients and thus is more acceptable than conventional management.

Enhanced recovery programs in lung cancer surgery: systematic review and meta-analysis of randomized controlled trials

“…Finally, these seven studies were judged to meet all the eligibility criteria and were included in our review. 18 – 24…”

“…The seven included RCTs were published between 2008 and 2017. Six of them were single-center RCTs 18 – 20 , 22 – 24 and only one study was a multicenter RCT. 21 There were five papers written in English language 18 , 19 , 21 – 23 and two papers written in Chinese language.…”

“…This review comprised a total of 486 surgical patients who were consecutively enrolled from 2007 to 2016. Approximately half of these patients were from China (n=217; ratio=44.7%), 18 – 20 , 24 followed by 209 patients from Europe (ratio=43.0%) 21 , 22 and 60 patients from the Middle East (ratio=12.3%). 23 Half of these patients were randomized to the ERAS group (n=243) and the other half to the control group (n=243).…”

“…The number of ERAS elements utilized in all seven RCTs ranged from 5 to 11. 18 – 24 They varied across these seven RCTs, but overlapped for some common components, as shown in Table 3 .…”

Fast-track rehabilitation after anatomical lung resection: prospective single-center non-randomized trial

“…В то же время в рандомизированном исследовании Q. Dong и соавт. [11] проанализированы результаты применения протокола у пациентов после пневмонэктомии по поводу центрального рака легкого, в котором авторы отметили статистически значимое сокращение стоимости и сроков стационарного лечения, более раннее восстановление моторики желудочно-кишечного тракта в группе пациентов, пролеченных по программе ускоренной реабилитации, без значимых различий в частоте послеоперационных осложнений. Это подчеркивает, что адаптация протокола ускоренной реабилитации критически важна именно у пациентов с расширенными операциями, где уменьшение доступа часто затруднено по объективным причинам в силу распространенности первичного заболевания, необходимости выполнения расширенных резекций c высоким риском развития периоперационных осложнений.…”