Rectal Cancer Treatment pp 8-13
Fast-Track Colonic Surgery: Status and Perspectives
Multi-modal rehabilitation with an emphasis on preoperative information, reduction of surgical stress responses, optimized dynamic pain relief with continuous epidural analgesia and early mobilization and oral nutrition may reduce hospital stay, morbidity, convalescence, and costs (fast-track surgery). Current results from fast-track colonic surgery suggest that postoperative pulmonary, cardiovascular, and muscle function are improved and body composition preserved as well as a normal oral intake of energy and protein can be achieved. Consequently, hospital stay is reduced to about 2–4 days, with decreased fatigue and need for sleep in the convalescence period. Despite a higher risk for readmissions, overall costs and morbidity seem to be reduced. Existing data from several institutions support the concept of fast-track colonic surgery to improve postoperative organ functions, thereby allowing for early rehabilitation with decreased hospital stay, convalescence, and costs. Further data are needed frommulti-national institutions on morbidity, safety, and costs.
Unable to display preview. Download preview PDF.
- 6.Jørgensen H, Wetterslev J, Mønniche S, Dahl JB (2001) Epidural local anaesthetics vs opioid based analgesic regiments on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery (Cochrane review). Cochrane Library, issue 2,. Oxford: Update SoftwareGoogle Scholar
- 9.Henriksen MG, Jensen MB, Hansen HV, Jespersen TW, Hessov I (2002) Enforcedmobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery. Nutrition1 8:147–152Google Scholar
- 11.Henriksen MG, Hansen HV, Hessov I (2002) Early oral nutrition after elective colorectal surgery: influence of balanced analgesia and enforced mobilization. Nutrition 18:266–269Google Scholar
- 13.Hjort Jakobsen D, Sonne E, Basse L, Bisgaard T, Kehlet H (2004) Convalescence after colonic resection with fast-track vs. conventional care. Scand J Surg (in press)Google Scholar
- 15.Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859CrossRefPubMedGoogle Scholar
- 23.Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L and the Danish study group on perioperative fluid therapy (2003) Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens. Ann Surg 238:641–648CrossRefPubMedGoogle Scholar