Fast-Track Versus Standard Care in Laparoscopic High Anterior Resection

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.

Patient Satisfaction and Quality of Life with Enhanced Recovery Protocols

“…This article aimed to review the literature in comparing patient satisfaction and QOL following treatment with an enhanced recovery protocol after colorectal surgery to that following standard postoperative care. The 15,18,23 albeit with small differences in outcome that disappear over time. The cause of higher pain scores in the early postoperative period in these select studies remains unclear, and could possibly be related to more enforced early mobilization, lack of routine use of regional or epidural pain management, or decreased administration of oral or intravenous opioid pain relief in favor of nonopioid multimodal therapy.…”

“…Four studies reported no difference. 16,[19][20][21] Jakobsen et al 22 and Mari et al 23 reported faster return to activities within the ERAS group. Only Delaney et al 15 reported worse emotional and mental health scores at discharge in the ERAS group as measured by the SF-36 instrument, which is likely attributed to earlier time of discharge (shorter length of stay) in the ERAS group.…”

“…16,19,20,25,27 Three studies reported lower pain scores in the ERAS group, 24,26,29 whereas three studies reported higher pain scores for patients treated in an ERAS pathway or a mixed effect of the ERAS pathway on pain scores. 15,18,23 Delaney et al 15 reported higher pain scores in the ERAS group at discharge, which is likely attributed to earlier day of discharge (shorter length of stay) in the ERAS group compared with the standard care group, and those differences disappeared by POD 10. Mari et al 23 reported that patients within the ERAS group had higher pain at 1 hour after surgery, but this difference disappeared by 5 hours, and by POD 1 the ERAS group actually reported lower pain scores than the standard care group.…”

“…15,18,23 Delaney et al 15 reported higher pain scores in the ERAS group at discharge, which is likely attributed to earlier day of discharge (shorter length of stay) in the ERAS group compared with the standard care group, and those differences disappeared by POD 10. Mari et al 23 reported that patients within the ERAS group had higher pain at 1 hour after surgery, but this difference disappeared by 5 hours, and by POD 1 the ERAS group actually reported lower pain scores than the standard care group. Thiele et al 18 reported higher pain scores on PODs 1 to 3 in the ERAS group for patients undergoing open colorectal surgery, but no difference in pain scores was found for those undergoing laparoscopic surgery.…”

“…Six reported no difference in fatigue, 15,16,19,20,24,25 whereas five reported reduced fatigue for those treated in an ERAS pathway. 22,23,[26][27][28] No studies reported worsened fatigue within an ERAS pathway.…”