First Department of General Surgery, Agia Olga Hospital, Athens, Greece.
Dig Surg. 2012;29(4):301-9. doi: 10.1159/000342554. Epub 2012 Sep 3.
Data on the role of laparoscopy within an enhanced recovery protocol for rectal cancer patients is rather limited. The aim of the study was to investigate the role of laparoscopy within a 'fast-track' protocol in patients who underwent sphincter-preserving surgery for rectal cancer.
PATIENTS/METHODS: 156 consecutive patients with low rectal cancer from three centers were assigned in four groups: the open fast track (OPEN-FT), the laparoscopic fast track (LAP-FT), the open (OPEN), and the laparoscopic (LAP). The fast-track protocol was applied in one center and traditional care in the other two. All patients underwent sphincter-preserving surgery and were followed-up for 30 days.
Overall morbidity was less in the fast-track groups (p = 0.007). On the other hand, no statistical significance could be identified in mortality, readmission or reoperations rates among the groups (p = 0.562, p = 0.896, p = 0.238). Fast-track patients required significantly less intramuscular opioids for postoperative analgesia (p < 0.001). Primary (p < 0.001) and total hospital stays (p < 0.001) were significantly shorter in the fast-track groups.
The implementation of a fast-track protocol is feasible and safe in low rectal cancer patients. Laparoscopy seems to be a basic element of such protocol as it further enhances recovery and reduces morbidity.
关于腹腔镜在直肠癌患者加速康复方案中的作用的数据相当有限。本研究的目的是调查腹腔镜在保留肛门的直肠癌患者“快速通道”方案中的作用。
患者/方法：来自三个中心的 156 例低位直肠癌患者被分为四组：开腹快速通道（OPEN-FT）、腹腔镜快速通道（LAP-FT）、开腹（OPEN）和腹腔镜（LAP）。一个中心采用快速通道方案，另外两个中心采用传统护理。所有患者均行保肛手术，并随访 30 天。
总体并发症发生率在快速通道组较低（p = 0.007）。另一方面，各组之间的死亡率、再入院率或再手术率无统计学意义（p = 0.562、p = 0.896、p = 0.238）。快速通道组术后肌肉内阿片类药物的镇痛需求明显减少（p < 0.001）。快速通道组的主要（p < 0.001）和总住院时间（p < 0.001）明显缩短。
在低位直肠癌患者中实施快速通道方案是可行且安全的。腹腔镜似乎是该方案的基本要素，因为它进一步促进了患者的康复并降低了发病率。
