Department of Surgery, University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
J Surg Res. 2010 Jul;162(1):11-6. doi: 10.1016/j.jss.2010.02.008. Epub 2010 Mar 9.
Enhanced Recovery after Surgery (ERAS) programs have gained popularity with potential to accelerate recovery and reduce morbidity after colectomy. We were interested in comparing recovery after open right colectomy within an ERAS program compared with laparoscopic right colectomy in a standard care perioperative environment.
Between October 2005 and June 2009, prospective data were collected on consecutive patients undergoing elective open right colectomy within an established ERAS setting (OpERAS). Similarly, between March 2008 and June 2009, data were collected on consecutive patients undergoing laparoscopic right hemicolectomy with conventional care (LapCon). Exclusion criteria for both groups were: ASA >or= 4, formation of a stoma, and dementia or mental illness rendering the patient unable to comply with instructions. Perioperative variables were collected. The surgical recovery score (SRS) was used as a validated means to measure convalescence on d 1, 3, 7, 30, and 60 postoperatively.
There were 74 patients in the OpERAS and 39 patients in the LapCon groups. At baseline, there were no significant demographic differences except that more patients had malignancy in OpERAS group. Mean operating time was longer in the LapCon group. Median day stay was 4 (3-28) in OpERAS and 5 (2-18) in LapCon (P = 0.032). There was no statistical difference in the incidence of complications or the severity of complications. There were no significant differences in SRS after surgery at any time point.
When perioperative care is optimized, recovery after elective open right hemicolectomy is comparable with laparoscopic resection. Studies looking at the combination of laparoscopy and ERAS are warranted.
加速康复外科（ERAS）方案越来越受到关注，有潜力加速结直肠切除术后的康复并降低发病率。我们有兴趣比较在 ERAS 方案下进行的开放式右半结肠切除术与标准围手术期环境下进行的腹腔镜右半结肠切除术的恢复情况。
2005 年 10 月至 2009 年 6 月，在既定的 ERAS 环境下（OpERAS）连续收集接受择期开放式右半结肠切除术的患者的前瞻性数据。同样，在 2008 年 3 月至 2009 年 6 月期间，收集接受常规护理腹腔镜右半结肠切除术的连续患者的数据（LapCon）。两组的排除标准均为：ASA≥4、造口形成和痴呆或精神疾病使患者无法遵守医嘱。收集围手术期变量。使用手术恢复评分（SRS）作为测量术后第 1、3、7、30 和 60 天康复的有效方法。
OpERAS 组有 74 例患者，LapCon 组有 39 例患者。在基线时，除 OpERAS 组有更多的患者患有恶性肿瘤外，两组在人口统计学上没有显著差异。腹腔镜组的平均手术时间较长。OpERAS 组的中位住院天数为 4 天（3-28 天），LapCon 组为 5 天（2-18 天）（P=0.032）。两组并发症的发生率和严重程度无统计学差异。在任何时间点，术后 SRS 均无显著差异。
当优化围手术期护理时，择期开放式右半结肠切除术的恢复情况与腹腔镜切除术相当。有必要进行腹腔镜与 ERAS 联合的研究。
