Francesco Feroci, MD, Elisa Lenzi, MD, Maddalena Baraghini, MD, Stefano Cantafio, MD, Luca Moraldi, MD, Gianfranco Giaconi, MD, Katrin C Kroning, MD, Marco Scatizzi, MD. General Surgery Department, Misericordia e Dolce Hospital, Prato, Italy
Purpose: The aim of this study was to investigate whether laparoscopic colorectal resection improved recovery within an enhanced recovery program.
Methods: This study was designed as a query of a prospectively maintained colorectal database to identify 350 patients who underwent elective colorectal resection with primary anastomosis for colorectal cancer between January 1, 2005 and December 31, 2009. Patients were categorized into two groups (laparoscopic and open resection), and demographic, treatment, and outcome variables were independently reviewed for accuracy. A detailed fast-track protocol was prepared and distributed to all patients, department doctors and nurses to standardize the treatment.
Results: Two hundred nine patients underwent laparoscopic-assisted colorectal resection, and 141 had open surgery. There was no difference between the two groups in terms of age, sex, BMI, ASA, co-morbidity, previous abdominal surgery, preoperative chemoradiotherapy, cancer site and AJCC 2002 staging. Twenty-three patients in the laparoscopic group required conversion to an open procedure due to hemorrhage, tumor extension or technical difficulties. Laparoscopic patients had earlier tolerance of diet, bowel movement, flatus and stool canalization, mobilization, suction drain removal and interruption of analgesic drug administration. Length of postoperative stay was shorter (4 vs. 7 days, p = 0.0004), and fewer postoperative non-surgical complications (3 vs. 13% p = 0.009) were registered for the laparoscopic group.
Conclusion: This study suggests that within an enhanced recovery program, laparoscopic resection may provide the best short-term clinical outcomes for patients with resectable colorectal cancer.
Program Number: S026