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Original Paper

Multimodal Perioperative Rehabilitation in Elective Conventional Resection of Colonic Cancer: Results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’

Braumann C.a · Guenther N.a · Wendling P.b · Engemann R.c · Germer C.T.d · Probst W.e · Mayer H.-P.f · Rehnisch B.g · Schmid M.h · Nagel K.i · Schwenk W.a

Author affiliations

aDepartment of General, Visceral, Vascular and Thoracic Surgery, Charité – University of Medicine, Berlin, bKliniken des Main-Taunus-Kreises GmbH, Bad Soden, cKlinikum Aschaffenburg, dKlinikum Nürnberg, eAmmerland Klinik GmbH, Westerstede, fHunsrück Klinik Kreuznacher Diakonie, Simmern, gKlinikum des Landkreises Löbau-Zittau gGmbH, Zittau, hWestpfalz-Klinikum GmbH, Standort III, Kirchheimbolanden, and iMarienhospital Aachen, Germany

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 09, 2008
Accepted: November 13, 2008
Published online: March 05, 2009
Issue release date: May 2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 4

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU

Abstract

Aim: Multimodal perioperative rehabilitation in patients undergoing curative conventional colonic resection for cancer has not yet been studied in a multicenter setting. In 2005, a nationwide quality assurance program was initiated in Germany in an unselected patient population. Methods: The prospective multicenter data collection includes patients from 24 German hospitals. All hospitals had established ‘fast-track’ rehabilitation as the standard perioperative treatment in elective colonic resection, and all patients entered the registry. Results: 748 of 2,047 fast-track patients (36.5%) underwent open resection of colonic cancer. The median age of the 380 female and 368 male patients was 71 (26–96) years. Compliance was high for epidural analgesia (89%), systemic basic nonopioid analgesia (93%), ‘restrictive’ intraoperative intravenous fluids (81%), oral feeding (73%) and enforced mobilization (84%) on the day of surgery. Surgical complications were diagnosed in 20%, general morbidity occurred in only 13% of all patients, and 3 patients (0.4%) died in the early postoperative period. Readmission within 30 days of discharge was necessary in 27 patients (4%). Conclusions: Compliance with fast-track measures was high, and general morbidity was low in a population of patients undergoing multimodal perioperative rehabilitation for conventional colonic cancer resection.

© 2009 S. Karger AG, Basel


References

  1. Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630–641.
  2. Senagore AJ, Delaney CP, Mekhail N, Dugan A, Fazio VW: Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg 2003;90:1195–1199.
  3. Kehlet H: Future perspectives and research initiatives in fast-track surgery. Langenbecks Arch Surg 2006;391:495–498.
  4. Bundgaard-Nielsen M, Holte K, Secher NH, Kehlet H: Monitoring of peri-operative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand 2007;51:331–340.
  5. Mattei P, Rombeau JL: Review of the pathophysiology and management of postoperative ileus. World J Surg 2006;30:1382–1391.
  6. Kehlet H, Dahl JB: Anaesthesia, surgery and challenges in postoperative recovery. Lancet 2003;362:1921–1928.
  7. Henriksen MG, Jensen MB, Hansen HV, Jespersen TW, Hessov I: Enforced mobilization, early oral feeding and balanced analgesia improve convalescence after colorectal surgery. Nutrition 2002;18:147–152.
  8. Kehlet H: Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res 2005;165:8–13.
  9. Andersen J, Hjort-Jakobsen D, Christiansen PS, Kehlet H: Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery. Br J Surg 2007;94:890–893.
  10. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al: Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005;24:466–477.
  11. Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J: Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 2005;92:1354–1362.
  12. Wind J, Polle SW, Fung Kon Jin PH, et al: Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006;93:800–809.
  13. Maessen J, Dejong CH, Hausel J, et al: A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 2007;94:224–231.
  14. Schwenk W, Günther N, Wendling P, et al: ‘Fast-track’ rehabilitation for elective colonic surgery in Germany-prospective observational data from a multi-centre quality assurance programme. Int J Colorectal Dis 2008;23:93–99.
  15. Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW: Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 2003;46:503–509.
  16. Raue W, Haase O, Junghans T, Scharfenberg M, Müller JM, Schwenk W: ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 2004;18:1463–1468.
  17. Basse L, Raskov HH, Hjort JD, et al: Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 2002;89:446–453.
  18. Nelson H, Sargent DJ, Wieand HS, et al: A comparison of laparoscopically assisted and open colectomy for colon cancer: clinical outcomes of Surgical Therapy Study Group. N Engl J Med 2004;350:2050–2059.
  19. Veldkamp R, Kuhry E, Hop WC, et al: Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005;6:477– 484.
  20. Guillou PJ, Quirke P, Thorpe H, et al: Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365:1718–1726.
  21. Marusch F, Koch A, Schmidt U, et al: ‘Colon/rectal carcinoma’ prospective studies as comprehensive surgical quality assurance (in German). Chirurg 2002;73:138–145.
  22. Kehlet H, Büchler MW, Beart RW Jr, Billingham RP, Williamson R: Care after colonic operation: is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 2006;202:45–54.
  23. Pessaux P, Regimbeau JM, Dondero F, Plasse M, Mantz J, Belghiti J: Randomized clinical trial evaluating the need for routine nasogastric decompression after elective hepatic resection. Br J Surg 2007;94:297–303.
  24. Marusch F, Koch A, Schmidt U, et al: Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study. Int J Colorectal Dis 2001;16:362–369.
  25. Marusch F, Gastinger I, Schneider C, et al: Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results. Surg Endosc 2001;15:116–120.
  26. Schwenk W, Raue W, Haase O, Junghans T, Müller JM: ‘Fast-track’ colonic surgery: first experience with a clinical procedure for accelerating postoperative recovery (in German). Chirurg 2004;75:508–514.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 09, 2008
Accepted: November 13, 2008
Published online: March 05, 2009
Issue release date: May 2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 4

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU


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