Skip to main content

Advertisement

SpringerLink
Log in

Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The concept of enhanced recovery after surgery (ERAS) is a modern regime of care, and numerous studies have proved its beneficial impact on recovery after colorectal surgery. However, little is known about patients’ continuing recovery after discharge. Therefore, the purpose of this study was to describe patient-reported recovery after colorectal cancer surgery in the context of ERAS from the day of discharge until 1 and 6 months after surgery.

Method

Assessments were made at discharge, at 1 month and at 6 months after surgery using the questionnaire Postoperative Recovery Profile (PRP). In all, 119 patients recovering from abdominoperineal resection, rectal resection, or colonic resection completed all three assessments.

Results

The global score of recovery showed that no patient experienced being fully recovered at discharge. After rectal resection, patients frequently reported being not at all recovered. One month after surgery, patients recovering from colonic resection reported significant improvements regarding 11 of 17 questionnaire items, whereas abdominoperineal resection patients reported no significant improvements regarding any item. Instead, significantly higher levels of problems were reported in the items fatigue, muscle weakness and feeling down. Rectal resection patients reported significant improvements between 1 and 6 months after surgery regarding 7 of 19 items. However, the item gastrointestinal function distinguished, as patients reported significant deterioration towards higher levels of problems 6 months after surgery.

Conclusion

This study elucidates the difference between groups of colorectal patients and the diverse patterns of their recovery, implying different needs in terms of prolonged support after discharge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lassen K, Soap M, Nygren J, Cox BW, Hendry PO, Spies C, Dejong CHC (2011) Consensus review of optimal perioperative care in colorectal surgery. Arch Surg 144:961–969

    Article  Google Scholar 

  2. Allvin R, Berg K, Idvall E, Nilsson U (2007) Postoperative recovery: a concept analysis. J Adv Nurs 57:552–558

    Article  PubMed  Google Scholar 

  3. Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793

    Article  PubMed  Google Scholar 

  4. American Society of Anesthesiologists http://www.asahq.org/clinical/physicalstatus.htm [2013-11-22]

  5. Hendry PO, Hausel J, Nygren J, Lassen K, Dejong CH, Ljungqvist O, Enhanced Recovery After Surgery Study Group (2009) Determinants of outcome after colorectal resection within an enhanced recovery programme. Br J Surg 96:197–205. doi:10.1002/bjs.6445

    Article  CAS  PubMed  Google Scholar 

  6. Smith JJ, Lee J, Burke C, Contractor KB, Dawson PM (2002) Major colorectal cancer resection should not be denied to the elderly. Eur J Surg Oncol 28:661–666

    Article  CAS  PubMed  Google Scholar 

  7. Schwenk W, Neudecker J, Raue W, Haase O, Muller JM (2006) “Fast track” rehabilitation after rectal cancer resection. Int J Color Dis 21(6):547–553

    Article  CAS  Google Scholar 

  8. Fearon KC, Luff R (2003) The nutritional management of surgical patients: enhanced recovery after surgery. Proc Nutr Soc 62:807–811

    Article  PubMed  Google Scholar 

  9. Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322:473–476

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbolle P, Hendel H et al (2002) Accelerated postoperative recovery program after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89:446–453

    Article  CAS  PubMed  Google Scholar 

  11. Aasa A, Hovbäck M, Berterö CM (2013) The importance of preoperative information for patient participation in colorectal surgery care. J Clin Nurs 22:1604–1612

    Article  PubMed  Google Scholar 

  12. Taylor C, Burch J (2011) Feedback on an enhanced recovery programme for colorectal surgery. Br J Nurs 20:286–290

    Article  PubMed  Google Scholar 

  13. Lithner M, Johansson J, Andersson E, Jakobsson U, Palmquist I, Klefsgard R (2012) Perceived information after surgery for colorectal cancer—an explorative study. Color Dis 14:1340–1350

    Article  CAS  Google Scholar 

  14. Norlyk A, Harder I (2011) Recovering at home: participating in a fast-track colon cancer surgery programme. Nurs Inq 18:165–173

    Article  PubMed  Google Scholar 

  15. Blazeby JM, Soulsby M, Winstone K, King PM, Bulley S, Kennady RH (2009) A qualitative evaluation of patients’ experiences of an enhanced recovery programme for colorectal cancer. Color Dis 12:e236–e242

    Article  Google Scholar 

  16. Burch J (2012) Enhanced recovery and nurse-led telephone follow-up post surgery. Br J Nurs 21:24–29

    Article  Google Scholar 

  17. Wennström B, Warrén Stomberg M, Modin M, Skullman S (2010) Patient symptoms after colonic surgery in the era of enhanced recovery—a long-term follow-up. J Clin Nurs 19:666–672

    Article  PubMed  Google Scholar 

  18. Allvin R, Ehnfors M, Rawal N, Svensson E, Idvall E (2009) Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability. J Eval Clin Pract 15:411–419

    Article  PubMed  Google Scholar 

  19. Allvin R, Svensson E, Rawal N, Ehnfors M, Kling AM, Idvall E (2011) The Postoperative Recovery Profile (PRP)—a multidimensional questionnaire for evaluation of recovery profiles. J Eval Clin Pract 17:236–243

    Article  PubMed  Google Scholar 

  20. Avdic A, Svensson E. Svenssons method 1.1 ed. Örebro 2010 Interactive software supporting Svenssons method. Accessed from http://www.oru.se/hh/Elisabeth-Svensson/Svenssons_metod 2013-05-08

  21. Svensson E (1998) Ordinal invariant measures for individual and group changes in ordered categorical data. Stat Med 17:2923–2936

    Article  CAS  PubMed  Google Scholar 

  22. Field A (2013) Discovering statistics using IBM SPSS statistics. Sage Publications Ltd, London

    Google Scholar 

  23. Fingren J, Lindholm E, Carlsson E (2013) Perceptions of phantom rectum syndrome and health-related quality of life in patients following abdominoperineal resection for rectal cancer. J Wound Ostomy Cont Nurs 40:280–286

    Article  Google Scholar 

  24. Ovesen P, Kroner K, Ornsholt J, Bach K (1991) Phantom-related phenomena after rectal amputation: prevalence and clinical characteristics. Pain 44:289–291

    Article  CAS  PubMed  Google Scholar 

  25. Desnoo L, Faithfull S (2006) A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery. Eur J Cancer Care 15:244–251

    Article  CAS  Google Scholar 

  26. Karanjia N, Schache D, Heald R (1992) Function of the distal rectum after low anterior resection for carcinoma. Br J Surg 79:114–116

    Article  CAS  PubMed  Google Scholar 

  27. Emmertsen KJ, Laurberg S (2013) Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 100:1377–1387

    Article  CAS  PubMed  Google Scholar 

  28. Siassi M, Hohenberger W, Losel F, Weiss M (2008) Quality of life and patient’s expectations after closure of a temporary stoma. Int J Colorectal Dis 23:1207–1212

    Article  PubMed  Google Scholar 

  29. O’Leary DP, Fide CJ, Foy C, Lucarotti ME (2001) Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg 88:1216–1220

    Article  PubMed  Google Scholar 

  30. Kleinbeck SV (2000) Self-reported at-home postoperative recovery. Res Nurs Health 23:461–472

    Article  CAS  PubMed  Google Scholar 

  31. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S (2000) Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 84:11–15

    Article  CAS  PubMed  Google Scholar 

  32. Allvin R, Ehnfors M, Rawal N, Idvall E (2008) Experiences of the postoperative recovery process: an interview study. Open Nurs J 2:1–7

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Doctor Renée Allvin, Örebro University Hospital, and Professor Bengt Jeppsson, Skane University Hospital, for valuable advice and support.

Author information

Authors and Affiliations

  1. Department of Surgery, Skane University Hospital, Inga Marie Nilssons gata 47, 20502, Malmö, Sweden

    Jenny Jakobsson

  2. Department of Care Science, Malmö University, Malmö, Sweden

    Jenny Jakobsson, Ewa Idvall & Christine Wann-Hansson

  3. Department of Intensive Care and Perioperative Medicine, Skane University Hospital, Malmö, Sweden

    Ewa Idvall

  4. The Swedish Institute for Health Sciences, Lund University, Lund, Sweden

    Christine Wann-Hansson

Authors
  1. Jenny Jakobsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ewa Idvall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Wann-Hansson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jenny Jakobsson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jakobsson, J., Idvall, E. & Wann-Hansson, C. Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study. Int J Colorectal Dis 29, 989–998 (2014). https://doi.org/10.1007/s00384-014-1939-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-014-1939-2

Keywords

Search

Navigation