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Impact of fast-track care program in laparoscopic rectal cancer surgery: a cohort-comparative study

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Abstract

Background

Fast-track care programs after surgery improve recovery and decrease the length of hospital stay and postoperative morbidity in colonic cancer. However, the true impact of these programs on morbidity rates after rectal cancer surgery remains unclear. We aimed to assess the feasibility and impact of the fast-track program on postoperative outcomes after restorative laparoscopic rectal cancer resection and temporary loop ileostomy.

Methods

This single-center observational study assessed data of patients undergoing elective rectal cancer surgery during a defined period before (standard group) and after the introduction of a fast-track program (fast-track group) from a prospectively maintained database. The primary endpoint was postoperative 90-day morbidity. Secondary endpoints were 30-day morbidity, fast-track program compliance, length of hospital stay, and readmission rate.

Results

Overall, 336 patients (n = 176, standard group; n = 160, fast-track group) were assessed; there was no significant between-group difference in the patients’ baseline characteristics (age, sex, body mass index, comorbidities, or neoadjuvant treatment). The protocol compliance rate was 91.4% in the fast-track group. The 90-day morbidity and mean total length of hospital stay were significantly lower in the fast-track group than in the standard group (34% vs 49%, respectively, p < 0.01 and 8.96 days vs 10.2 days, p < 0.01, respectively). There was no difference in readmission rates. Multivariate analysis revealed the fast-track program to be the only predictive factor of postoperative morbidity.

Conclusion

Fast-track programs can be safely implemented following rectal cancer surgery to reduce the overall morbidity rate and length of hospital stay without adversely increasing the readmission rate.

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Authors and Affiliations

  1. Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France

    Hélène Meillat, Victor Serenon, Cécile de Chaisemartin & Bernard Lelong

  2. Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France

    Clément Brun & Marion Faucher

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  1. Hélène Meillat
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  2. Victor Serenon
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  3. Clément Brun
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  4. Cécile de Chaisemartin
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  5. Marion Faucher
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  6. Bernard Lelong
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Correspondence to Hélène Meillat.

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Hélène Meillat, Victor Serenon, Clément Brun, Cécile de Chaisemartin, Marion Faucher, and Bernard Lelong have no conflict of interest or financial ties to disclose.

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Meillat, H., Serenon, V., Brun, C. et al. Impact of fast-track care program in laparoscopic rectal cancer surgery: a cohort-comparative study. Surg Endosc 36, 4712–4720 (2022). https://doi.org/10.1007/s00464-021-08811-5

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  • DOI: https://doi.org/10.1007/s00464-021-08811-5

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