Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery

BACKGROUND Fast-track surgery(FTS)is a modern nursing approach that has gained popularity in the perioperative phase of surgery.AIM To investigate the impact of FTS on perioperative care for hepatobiliary surgery.METHODS A retrospective analysis was performed on 98 patients who underwent hepato-biliary surgery and were admitted to our hospital from August 2021 to October 2023.They were divided into an observation group and a control group with 49 patients in each group according to different nursing directions.The control group was treated with standard nursing and the observation group was treated with FTS concept nursing.The length of hospital stay,visual analog scale(VAS)score,wound complications,nursing satisfaction,self-rating scale(SAS)score,and SF-36 quality of life(QoL)score were compared between the two groups before and after care.RESULTS The duration of hospitalization,hospitalization cost,operation time,first im-plantation time,exhaust time,and first defecation time were shorter than the observation group(P<0.05).Additionally,the observation group showed a sig-nificant difference between the VAS and SAS scores on days 1,3,and 7(P<0.05).The complication rate in the observation group was 4.05%was significantly lower than the 18.36%in the control group,and the comparison groups were statistically significant(χ2=5.018,P=0.025).The observation group had a significantly higher level of nurse satisfaction(94.92%)than the control group(79.59%;χ2=6.078,P=0.014).Both groups showed higher QoL scores after nursing care,with higher scores in the observation group than in the control group(P=0.032).CONCLUSION FTS in patients undergoing hepatobiliary surgery can effectively improve negative mood,QoL,and nursing sa-tisfaction;reduce wound complications;and accelerate patient rehabilitation.

FTS护理在冠脉搭桥手术患者围手术期中的应用效果

目的探讨加速康复外科(FTS)护理在冠脉搭桥手术(CABG)患者围手术期中的应用效果。方法选择2021年7月至2022年7月河南省胸科医院收治的接受常规围手术期护理的43例CABG患者作为研究对象,将其纳入对照组。另选取2022年8月至2023年8月医院收治的接受FTS围手术期护理的43例CABG患者作为研究对象,将其纳入观察组。两组均连续护理至患者出院,并随访3个月,比较两组患者围手术期指标[重症加强护理病房(ICU)监护时间、首次排气时间、下床活动时间、住院时间];比较不同时点(麻醉诱导前、血管吻合时、术毕时)两组应急指标(呼吸、心率、平均动脉压);比较两组护理前、护理3个月时心功能指标[左室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]。结果住院期间,观察组ICU监护、首次排气、下床活动及平均住院时间均短于对照组(P<0.05);血管吻合时,两组患者呼吸、心率及平均动脉压均高于麻醉诱导前;术毕时,呼吸、心率及平均动脉压均低于血管吻合时,呈先上升后下降,观察组各时点均低于对照组(P<0.05);护理3个月时,两组LVEF高于护理前,LVESD及LVEDD低于护理前,观察组LVEF高于对照组,LVESD及LVEDD低于对照组(P<0.05)。结论FTS护理能够有效降低CABG患者应急反应,促进术后恢复,提高患者心功能。

Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

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

AIM:To analyze our results after the introduction of a fast-track(FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic Unit.METHODS:All patients(43) undergoing laparoscopic liver surgery between March 2004 and March 2010 were included and divided into two consecutive groups:Control group(CG) from March 2004 until December 2006 with traditional perioperative cares(17 patients) and fast-track group(FTG) from January 2007 until March 2010 with FT program cares(26 patients).Primary endpoint was the influence of the program on the postoperative stay,the amount of re-admissions,morbidity and mortality.Secondarily we considered duration of surgery,use of drains,conversion to open surgery,intensive cares needs and transfusion.RESULTS:Both groups were homogeneous in age and sex.No differences in technique,time of surgery or conversion to open surgery were found,but more malignant diseases were operated in the FTG,and then transfusions were higher in FTG.Readmissions and morbidity were similar in both groups,without mortality.Postoperative stay was similar,with a median of 3 for CG vs 2.5 for FTG.However,the 80.8% of patients from FTG left the hospital within the first 3 d after surgery(58.8% for CG).CONCLUSION:The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions,which leads to a reduction of the stay and costs.

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.

Early discharge after major gynaecological surgery: advantages of fast track surgery

Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.

Effect of fast track surgery care on knee joint function in patients with knee joint replacement surgery: A systematic review

Objective: To assess the effect of fast track surgery care on knee joint function in patients with knee joint replacement surgery. Methods: Eighteen databases were searched for randomized controlled trials, focusing on evaluation of fast track surgery care on knee joint function in patients with knee joint replacement surgery. Two people independently screened literatures and extracted data according to the inclusion criteria. Then the available data were analyzed with RevMan software (version 5.3.0). Descriptive techniques were performed when no available data could be used. Results: A total of 8 studies were included, for a total sample of 635 patients. The results showed that fast track surgery care can improve Hospital for Special Surgery Knee score at 2 months, 3 months, 6 months, and 1 years after operation [after 2 months (weighted mean difference (WMD), 15.2;95%CI, 13.58 to 16.82;P < 0.01);after 3 months (WMD, 9.42;95%CI, 7.80 to 11.04;P < 0.01);after 6 months,(WMD, 11.01;95%CI, 9.73 to 12.28;P < 0.01);after 1 years (WMD, 10.78;95%CI, 9.33 to 12.24;P < 0.01)]. Fast track surgery care can improve the knee score of American Knee Society Knee Score(WMD, 9.23;95%CI,0.86 - 17.6;P < 0.05), and reduce the incidence of postoperative deep vein thrombosis, constipation, pulmonary infection, urinary tract infection and other complications. Conclusion: Fast track surgery care can promote knee joint function recovery, reduce postoperative deep venous thrombosis, constipation, pulmonary infection and urinary tract infection. However, rigorous large sample and multicenter randomized controlled trials are needed for further validation.

Fast Track Gynaecologic Surgery in the Overweight and Obese Patient

Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.

基于FTS理念的围手术期全程护理对四肢创伤性骨折患者的应用价值

目的探究基于快速康复外科(FTS)理念的围手术期全程护理对四肢创伤性骨折患者的实际应用价值.方法选取该院2023年1月—2023年9月创伤骨科收治的64例四肢创伤性骨折患者为研究对象,按随机数字表法将其分为对照组与观察组.对照组(n=32)采用常规护理,观察组(n=32)采用基于FTS的全程护理.比较两组患者的实际护理效果.结果观察组术后的拔管时间、下床活动时间及住院时间均短于对照组,组间差异有统计学意义(P<0.05).观察组术后不同时间点的疼痛视觉模拟评分均低于对照组,护理后自我护理能力测定量表评分高于对照组,组间差异有统计学意义(P<0.05).观察组的压疮发生率为3.13%,低于对照组的15.62%%,差异有统计学意义(P<0.05).结论对四肢创伤性骨折患者实施基于FTS理念的围手术期全程护理,效果显著,值得推荐.

基于FTS理念的手术室护理对老年胆囊手术患者术后恢复效果的影响

目的分析基于快速康复外科(FTS)理念的手术室护理对老年胆囊手术患者术后恢复效果。方法选取2021年5月至2023年4月在我院接受手术治疗的86例老年胆囊手术患者,采用随机数字表法分为观察组(43例,采用基于FTS理念的手术室护理)和对照组(43例,采用常规手术室护理),对两组老年胆囊手术患者恢复时间和术后24 h疼痛程度、不良心理和应激指标水平改善情况以及并发症发生率进行对比。结果观察组老年胆囊手术患者首次排便、下床活动、恢复正常饮食、首次排气、肠鸣音恢复及住院时间均短于对照组,术后24 h疼痛评分低于对照组(P<0.05);两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分,肾上腺素(E)、血清皮质醇(COR)水平护理后均降低且观察组更低(均P<0.05)。观察并发症发生率低于对照组(P<0.05)。结论基于FTS理念的手术室护理有利于促进老年胆囊手术患者术后恢复效果,并降低患者术中应激程度,减轻负性情绪,减少感染、胆漏等并发症发生。

Fast Track Surgery and Its Outcome in Colorectal Surgery in a Tertiary Care Hospital

Background: Fast track surgery is an evidence-based multidisciplinary approach. The underlying principle is to enable patients to recover from surgery and leave the hospital sooner by minimizing the stress responses on the body during surgery. Our aim was to compare the outcome of fast-track protocol and conventional methods in colorectal surgery. Method: It was an observational cross-sectional study carried out at the Department of Surgery in different tertiary level hospitals, Dhaka Bangladesh during the period January 2014 to December 2017. Among this population, 50 patients were placed in the fast-track program (Group A) from January 2014 to December 2015 and 50 patients were in the conventional method (Group B), from January 2016 to December 2017. The fast-track patients were selected after receiving ethical approval from the Bangladesh College of Physician & Surgeons. Data analysis was done using the statistical package for social science (SPSS) for windows version 20. Results: The average age of the patients was 45.24 ± 16.65 years (range: 11 - 70 years) in the fast track group (Group A) and 43.24 ± 17.76 years in the conventional method (Group B). The majority were female between two groups, with 56% in group A and 52% in group B. General and surgical complications occurred in 9 (18%) patients and 11 (22%) patients respectively in group A. On the other hand in group B general and surgical complications occurred in 10 (20%) patients and 13 (26%) patients respectively. The average hospital stay was 9.24 ± 5.99 days in group A and the average hospital stay was 10.10 ± 6.04 days in group B. Conclusion: Making the decision to adopt fast-track surgery will challenge current traditional practice for all members of the multidisciplinary team across the whole local health community.

基于FTS的医护一体化护理模式在老年股骨颈骨折患者人工髋关节置换围手术期中的应用

目的构建基于快速康复外科(FTS)的医护一体化模式,探讨其在老年股骨颈骨折患者人工全髋关节置换术(THA)围手术期中的应用效果。方法选取河南省第二人民医院2019年2月1日至2022年7月1日接受THA的80例老年股骨颈骨折患者,根据随机数字表法分为FTS组(40例)、对照组(40例)。对照组接受常规护理干预,FTS组在常规护理基础上接受基于FTS的医护一体化模式针对性干预,比较两组康复效果(下床活动时间、疼痛持续时间、住院时间)、生活质量、髋关节功能[Harris髋关节功能评分表(Harris)]、并发症发生率(压力性损伤、下肢水肿、切口感染)。结果术后10 d,FTS组视觉模拟评分法(VAS)评分低于对照组(P<0.05),Harris、日常生活能力量表(ADL)评分高于对照组(P<0.05);FTS组并发症发生率为0.03%,低于对照组的0.20%(P<0.05);FTS组下床活动、疼痛消失及住院时间短于对照组(P<0.05)。结论基于FTS的医护一体化护理模式应用于老年股骨颈骨折患者THA围手术期中,能减轻术后疼痛,减少并发症发生,促进髋关节功能恢复,提高生活质量。

FTS护理模式对骨质疏松股骨转子间骨折患者术后康复进程及并发症的影响

目的探讨快速康复外科(FTS)护理模式对骨质疏松股骨转子间骨折患者术后康复进程及并发症的影响。方法选取2018年1月至2022年12月收治的116例骨质疏松股骨转子间骨折患者为研究对象,按照随机数字表法将其分为常规组和试验组,各58例。常规组给予常规护理干预,试验组给予FTS护理模式干预。比较两组的干预效果。结果干预后,两组的微型营养评估表(MNA)评分均升高,视觉模拟评分法(VAS)评分均降低,且试验组优于常规组(P<0.05)。干预后,试验组的Harris评分及髋关节功能优良率高于常规组(P<0.05)。试验组的自主下床时间及住院时间短于常规组,术后并发症总发生率低于常规组(P<0.05)。结论FTS护理模式可有效改善骨质疏松股骨转子间骨折患者的营养状况及疼痛程度,促进术后髋关节功能恢复,缩短康复进程,减少术后并发症。

FTS理念指导下床旁早期康复训练对妇科肿瘤手术患者预后的影响分析

目的探讨快速康复外科(fast track surgery,FTS)理念下床旁早期康复训练对妇科肿瘤手术患者预后的影响。方法随机选取2021年6月—2023年6月六盘水市妇幼保健院收治的100例妇科肿瘤患者为研究对象,依据不同护理方法分为两组,每组50例。对照组行常规护理,观察组在对照组基础上采用FTS理念下的床旁早期康复训练护理,比较两组患者术后恢复情况、盆底功能障碍评分、女性性功能指数、负面情绪评分与护理满意度。结果观察组首次排便时间为(23.01±4.23)h,短于对照组的(24.95±3.68)h,差异有统计学意义(t=2.447,P=0.016)。观察组简化盆底功能障碍问卷、医院焦虑抑郁量表评分均低于对照组,差异有统计学意义(P均<0.05)。观察组女性性功能指数、护理满意度均高于对照组,差异有统计学意义(P均<0.05)。结论基于FTS理念的床旁早期康复训练,可改善妇科肿瘤患者的术后恢复效果,有助于降低盆底障碍、性功能障碍风险,减轻负面情绪,并提升护理满意度。

激励式信念干预联合医护共同参与的FTS护理模式在脑胶质瘤患者围手术期护理中的应用价值

目的探讨激励式信念干预联合医护共同参与的快速康复外科(FTS)护理模式在脑胶质瘤患者中的应用效果.方法选取2019年6月—2023年6月莒县人民医院收治的70例脑胶质瘤患者为研究对象,按随机数字表法将其分为对照组和观察组,每组35例.对照组采用常规护理,观察组采用激励式信念干预联合医护共同参与的FTS护理模式.对比两组的负面情绪、生理应激、术后恢复情况、并发症发生率及护理满意度.结果护理后,观察组焦虑自评量表和抑郁自评量表评分均低于对照组,术毕心率、呼吸频率、收缩压、舒张压水平均低于对照组,术后下床活动时间、饮食恢复时间、住院时间均短于对照组,并发症发生率低于对照组,护理满意度高于对照组,组间差异有统计学意义(P<0.05).结论激励式信念干预联合医护共同参与的FTS护理模式可以减轻脑胶质瘤患者的负面情绪与生理应激反应,可减少并发症,促进术后康复,提高护理满意度.

FTS应用于达芬奇机器人辅助下宫颈癌根治术后患者的疗效观察

目的观察快速康复理念(FTS)应用于达芬奇机器人辅助下宫颈癌根治术后患者的临床应用效果。方法选取医院2020年1月—2021年1月收治的50名行达芬奇机器人辅助下宫颈癌根治术患者为研究对象,其中2020年1—6月入院的27例患者作为对照组,2020年7月—2021年1月入院的23例患者为观察组。对照组患者接受常规护理,而观察组在对照组的基础上接受FTS护理,对两组护理效果进行比较。结果观察组患者术后FS-FI量表性唤起、阴道润滑度、性高潮、性欲望、性满足评分高于对照组,性交疼痛低于对照组;观察组患者康复预后效果、对护理满意率均优于对照组;观察组患者并发症发生率低于对照组;各项指标组间比较差异均有统计学意义(P<0.05)。结论在接受达芬奇机器人辅助下宫颈癌根治术患者的术后护理中,应用FTS护理可以改善患者术后性生活质量,提高术后康复效果,并且有效降低并发症的同时也能提高患者对护理工作的满意程度。

Fast track clinical pathway implications in esophagogastrectomy

AIM： To investigate the feasibility of fast track clinica pathway for esophageal tumor resections. METHODS： One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied. Fast track clinical pathway included analgesia control, fluid infusion volume control, early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine, and full liquid diet 5 d after operation. RESULTS： Among 114 patients （84 men and 30 women）, 26 patients underwent fast track surgery, including 17 patients over 65 years old and 9 under 65 （P = 0.014）; 18 patients who had preoperative complications could not bear fast track surgery （P 〈 0.001）. No significant differences in tolerance of fast track surgery were attributed to differences in gender, differentiated degree or stage of tumor, pathological type of tumor, or operative incision. The median length of hospital stay was 7 d （5-28 d）, 4% patients were readmitted to hospital within 30 d of discharge. Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.CONCLUSION： The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results. Median length of hospital stay has been reduced to 7 d.

Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: A meta-analysis

AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.

Assessing outcomes after fast track surgical management of corpus cancer

Objective: The aim of the study was to audit the outcomes of patients with corpus cancer managed with a fast track surgery (FTS) program. Design: Clinical audit of outcomes after laparotomy for corpus cancer and managed by FTS principles. Setting: Tertiary hospital, University based subspecialty gynaecological oncology practice. Population or Sample: Consecutive patients with uterine corpus cancer. There were no exclusions. Methods: Three year audit of FTS Database. Main Outcome Measures: Ability to tolerate early oral feeding (EOF), length of stay (LOS), perioperative complication rate and readmission rate. Results: Sixty six patients were operated upon whose median age was 59.5 years. Forty six (70%) had stage I disease, 7 (11%) stage II, 9 (14%) stage III and 4 (6%) had stage IV disease. Twenty seven (41%) had lymph node sampling performed. Median operating time was 2.5 hours. Mean BMI was 30 kg/m2 (Range: 18 - 47). Fifty patients (76%) were classified as over-weight or obese. Twenty four patients (36%) had a “non-zero” performance status. Mean intraoperative EBL was 227 ml. Median LOS was 3.0 days. There were 3 (5%) intraoperative complications. There were no intraoperative ureteric, bowel or vascular injuries. Postoperatively, 13 (20%) patients experienced a total of 24 adverse events. Only 2 (3%) patients experienced complications greater than grade 2. Conclusion: This audit shows that in an unselected group of patients undergoing laparotomy as management for their uterine malignancy and managed by a FTS protocol, overall excellent results can be achieved.