Fast-track surgery has been shown to enhance postoperative recovery. The objective of the study was to determine the differences of fast-track surgery and conventional care for patients with gastroenteric neoplasms.
Methods and Study Design
We searched PubMed, EMBASE, and the Cochrane Library for related trials to compare hospital stay and rates of complications and readmission.
Results
Thirteen randomized controlled trials, with 1,962 patients, were included. Results showed the length of hospital stay was significantly reduced in the fast-track group. The complications rate was lowered in colorectal surgery. There were no significant differences in rate of readmissions.
Conclusions
Current trials show that fast-track surgery may reduce the length of hospital stay and lower the rate of complications of gastroenteric surgery.
BokeyE.L., ChapuisP.H., FungC., HughesW.J., KooreyS.G., BrewerD., NewlandR.C.: Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum, 38: 480–487, 1999.
3.
CuschieriA., FayersP., FieldingmJ., CravenJ., BancewiczJ., JoypaulV., CookP.: Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial — The Surgical Cooperative Group. Lancet, 347: 995–999, 1996.
RahbariN.N., ZimmermannJ.B., SchmidtT., KochM., WeigandM.A., WeitaJ.: Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg, 96: 331–341, 2009.
6.
KehletH.: Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaest, 78: 606–617, 1997.
7.
KehletH., WilmoreD.W.: Multimodal strategies to improve surgical outcome. Am J Surg, 183: 630–641, 2002.
8.
HoffmannH., KettelhackC.: Fast-track surgery — conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. Eur Surg Res, 49: 24–34, 2012.
9.
SongK.C., WangY.H., LiT., ZhangW.B., XuX.C.: Systemic review of fast-track surgery in patients undergoing laparoscopic colorectal resection. Zhonghua Wei Chang Wai Ke Za Zhi, 15: 1048–1052, 2012.
10.
JiangZ.W., LiJ.S., WangZ.M., LiN., LiuX.X., LiW.Y., ZhuS.H., DiaoY.Q., NaiY.J., HuangX.J.: The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy. Zhonghua Wai Ke Za Zhi, 45: 1314–1317, 2007.
11.
IonescuD., IancuC., IonD., Al-HajjarN., MargaritS., MocanL., MocanT., DeacD., BodeaR., VasianH.: Implementing fasttrack protocol for colorectal surgery: a prospective randomized clinical trial. World J Surg, 33: 2433–2438, 2009.
12.
KhooC.K., VickeryC.J., ForsythN., VinallN.S., Eyre-BrookI.A.: A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg, 245: 867–872, 2007.
13.
LeeT.G., KangS.B., KimD.W., HongS., HeoS.C., ParkK.J.: Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum, 54: 21–28, 2011.
14.
VlugM.S., WindJ., HollmannM.W., UbbinkD.T., CenseH.A., EngelA.F., GerhardsM.F., van WagensveldB.A., van der ZaagE.S., van GelovenA.A., SprangersM.A., CuestaM.A., BemelmanW.A., LAFA study group: Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg, 254: 868–875, 2011.
15.
WangG., JiangZ.W., XuJ., GongJ.F., BaoY., XieL.F., LiJ.S.: Fasttrack rehabilitation program vs conventional care after colorectal resection: a randomized clinical trial. World J Gastroenterol, 17: 671–676, 2011.
16.
WangQ., SuoJ., JiangJ., WangC., ZhaoY.Q., CaoX.: Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis, 14: 1009–1013, 2011.
17.
XuJ.M., ZhongY.S., ZhuD.X.: Application of the protocol of enhanced recovery after surgery in colorectal surgery. Zhonghua Wei Chang Wai Ke Za Zhi, 10: 238–244, 2007.
18.
YangD.J., ZhangS., HeW.L., ChenH.Y., CaiS.R., ChenC.Q., SongX.M., CuiJ., MaJ.P., ZhangC.H., HeY.L.: Fast track surgery accelerates the recovery of postoperative insulin sensitivity. Chin Med J (Engl), 125: 3261–3265, 2012.
19.
ZhuD.X., WeiY., RenL., PanX.O., LiangL., ZhaiS.Y., XuJ.M., ZhongY.S., XueZ.G., JinL., NiuW.X., QinX.Y., WuZ.H., WuZ.G.: Application of enhanced recovery program after surgery (ERAS) in patients undergoing radical resection for colorectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi, 15: 555–560, 2012.
20.
Chen HuJ., Xin JiangL., CaiL., Tao ZhengH., Yuan HuS., Bing ChenH., Chang WuG., Fei ZhangY., Chuan LvZ.: Preliminary experience of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer. J Gastrointest Surg, 16: 1830–1839, 2012.
21.
KimJ.W., KimW.S., CheongJ.H., HyungW.J., ChoiS.H., NohS.H.: Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg, 36: 2879–2887, 2012.
22.
LiuX.X., JiangZ.W., WangZ.M., LiJ.S.: Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery. J Parenter Enteral Nutr, 34: 313–321, 2010.
23.
WangD., KongY., ZhongB., LiJ.S.: Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg, 14: 620–627, 2010.
24.
YangD., ZhangS., HeW., ZhouX., ZhouY.: Fast-track surgery accelerates the recovery of postoperative humoral immune function in elective operation for colorectal carcinoma: a randomized controlled clinical trial. Natl Med J China, 92: 1112–1115, 2012.
