Implementation of the scientific evidence into daily practice – example from fast‐track colonic cancer surgery

Abstract

Fast-track surgery is feasible in an unselected patient population scheduled for elective colon cancer resections without compromising quality.

Long-term Results after Laparoscopic Resection for Colorectal Cancer within a Fast-track Regimen in the Elderly: A Prospective Study~!2009-10-21~!2010-01-27~!2010-04-22~!

“…In this context it should be mentioned that the median postoperative hospital stay in the present study was 5 days and not 3 days as planned, maybe due the relatively high comorbidity of the patients. A similar difference between planned and real discharge is seen in other studies, as well, but the important factor is probably that the principles for the fast-track regimen has been followed [9,12].…”

“…All patients had a perioperative fast-track regimen as first suggested by Kehlet and co-workers [11]. Our setup was the same as described by Hammer et al in their recent article about implementation of such a regimen into daily practice [12]. The regimen contained: no preoperative bowel cleansing, no drains nor tubes, mobilization and normal meal the evening on the day of surgery, epidural analgesia, oral laxatives, and a planned discharge on postoperative day 3.…”

Fast-track program in laparoscopic liver surgery: Theory or fact?

“…van Dam et al [8] found differences in open hepatic surgery of 161 patients after a FT program (6 d vs 8 d, P < 0.0001). In colon surgery the reduction of the stay is clearly proved in several studies [6,7,18] , up to 3-4 d. Differences between our FT program and classical clinical pathway for patients who undergo laparoscopic liver surgery begin preoperatively. Due to the special characteristics of liver surgery, the possibility of being discharged less than 3 d after surgical procedure may be inconceivable.…”

“…No increase of morbidity must be associated with the adoption of these therapeutic options, and normally a decrease of hospital stay may be reached. Evidence with these programs exists in colon surgery [6,7] , but there is still limited information about its feasibility in liver surgery, either open or laparoscopic [8][9][10] . We report our results after the implantation of a FT program in patients undergoing laparoscopic liver surgery in a specialized Unit of Hepatobiliarypancreatic Surgery.…”

Pathogenesis of morbidity after fast-track laparoscopic colonic cancer surgery

“…Perioperative care was provided in accordance with the department's standard protocol, primarily developed for open colonic surgery, as described previously [11]. However, epidural analgesia was not used.…”