Department of Surgery, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
Department of Surgery, Cuneo Hospital, Cuneo, Italy.
Surg Endosc. 2017 Nov;31(11):4393-4399. doi: 10.1007/s00464-017-5486-0. Epub 2017 Mar 13.
Previous studies reported that laparoscopic surgery (LPS) improved postoperative outcomes in patients undergoing colorectal surgery within an enhanced recovery program (ERP). However, the effect of minimally invasive surgery on each ERP item has not been clarified, yet. The aim of this study is to assess the impact of LPS on adherence to ERP items and recovery as measured by time to readiness for discharge (TRD).
Prospectively collected data entered in an electronic Italian registry specifically designed for ERP were reviewed. Patients undergoing elective colorectal surgery were divided into three groups: successful laparoscopy, conversion to open surgery, primary open surgery. Adherence to 19 ERP elements and postoperative outcomes were compared among groups. Multivariate regression analysis was used to identify whether LPS had an independent role to improve ERP adherence and postoperative outcomes.
714 patients (successful LPS 531, converted 42, open 141) underwent elective colorectal surgery within an ERP. Epidural analgesia was used in the 75.1% of open group patients versus 49.9% of LPS group patients (p = 0.012). After surgery, oral feeding recovery, i.v. fluids suspension, removal of both urinary and epidural catheters occurred earlier in the LPS group both in the overall series and in uneventful patients only. Mean TRD and length of hospital stay were significantly shorter in the LPS group (p < 0.001 for both). Overall morbidity rate was 18.7% in the LPS group versus 32.6% in the open group (p = 0.001). At multivariate analysis, LPS was significantly associated to an increased adherence to postoperative ERP items, a shorter TRD, and a reduced overall morbidity, whereas rectal surgery and new stoma formation impaired postoperative recovery.
The present study showed that a successful laparoscopic procedure had an independent role to increase the adherence to postoperative ERP and to improve short-term postoperative outcome.
先前的研究报告称，在加速康复方案（ERP）中，腹腔镜手术（LPS）改善了结直肠手术后患者的术后结局。然而，微创手术对每个 ERP 项目的影响尚未明确。本研究旨在评估 LPS 对 ERP 项目依从性和恢复的影响，以出院准备时间（TRD）衡量。
回顾性分析专门设计用于 ERP 的电子意大利注册处收集的数据。将择期行结直肠手术的患者分为三组：成功腹腔镜组、中转开腹手术组、初次开腹手术组。比较三组患者对 19 个 ERP 要素的依从性和术后结果。采用多变量回归分析确定 LPS 是否具有改善 ERP 依从性和术后结果的独立作用。
714 例（成功 LPS 531 例、中转 42 例、初次开腹 141 例）在 ERP 下行择期结直肠手术。硬膜外镇痛在开腹组患者中的使用率为 75.1%，而 LPS 组患者为 49.9%（p=0.012）。手术后，口服喂养恢复、静脉输液停止、导尿管和硬膜外导管拔除均在 LPS 组中更早发生，无论是在整个系列中还是在无并发症患者中均如此。LPS 组的平均 TRD 和住院时间明显缩短（均 p<0.001）。LPS 组总发病率为 18.7%，开腹组为 32.6%（p=0.001）。多变量分析显示，LPS 与术后 ERP 项目的更高依从性、更短的 TRD 和更低的总发病率显著相关，而直肠手术和新造口术则会损害术后恢复。
本研究表明，成功的腹腔镜手术具有增加术后 ERP 依从性和改善短期术后结局的独立作用。
