Laparoscopy in Combination with Fast Track Multimodal Management is the Best Perioperative Strategy in Patients Undergoing Colonic Surgery

Abstract

Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program. If open surgery is applied, it is preferentially done in FT care. This study was registered under NTR222 (www.trialregister.nl).

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…It may also reduce the prevalence of postoperative immunosuppression [111] while providing equivalence in cancer outcomes [112][113][114][115][116]. The debate during the last 5 years has centred around whether open surgery undertaken within an ERAS programme can match laparoscopic resection which is similarly optimised.…”

“…Readmission rates of [20 % were high in both arms of the first trial and in the open group of the second trial, but acceptable at 5 % in the laparoscopic arm of the latter trial. Recently, the Laparoscopy and/or Fast-track Multimodal Management Versus Standard Care (LAFA) study reported the results from its multicentre RCT which randomised between laparoscopic and open segmental colectomy within 9 Dutch centres [111]. The median primary and total stay in hospital was 2-days shorter after laparoscopic resection.…”

Enhanced Recovery After Surgery (ERAS) Implementation of a Protocol in Laparoscopic Colectomy, Initial Experience in a Single Institution in Argentina

“…This is possibly owing to the fact that it is an initial, reduced number of patients. The LAFA study shows similar results as regards morbidity in the four groups compared (laparoscopic surgery with and without ERAS and conventional surgery with and without ERAS), but clearly defines the benefits of combining both of these minimally invasive techniques, which translate into early discharge without a higher readmission rate in the case of laparoscopy with ERAS, considering it as a parameter of best outcome [15]. On the other hand, a metaanalysis published recently evaluates 6 prospective randomised trials of malignant colorectal disease operated laparoscopically with and without an ERAS protocol.…”

“…The Dutch prospective randomised LAFA trial, published in 2011, clearly shows how the patients who underwent laparoscopy benefited from multimodal care, with a shorter hospital stay and lower costs than those who were under conventional care and had undergone laparoscopy or open surgery [15 ].…”

“…Today, most elective surgeries are performed in this manner in our institution. In 2010, we introduced in our working team the concept of multimodal care (ERAS) and started by planning a protocol to be applied in our context with the hypothesis of reducing the global morbidity of colorectal surgery with conventional care, which is around 15 to 30% according to different series, both for the laparoscopic approach and for the conventional one [9][10][11][12][13][14][15][16][17][18][19].…”