Fast Track Laparoscopic Surgery: A Better Option For Treating Colorectal Cancer Than Conventional Laparoscopic Surgery

Background: Fast track surgery, a multimodal rehabilitation, has been recommended assurgical therapy for colorectal cancer.Fast track surgery (FTS) was first proposed by the Danish surgeon Kehlet et al. Whofocused on using a variety of measures to control the patients’ perioperativepathophysiological reaction, to reduce surgical stress and complications, enhancepostoperative rehabilitation and to improve prognosis [31]. FTS can be considered as amultimodal perioperative care. The main components include: simplified bowl preparation,skipping routine mechanical enema, using epidural anesthesia and analgesia, laparoscopicsurgery, early removal of the nasogastric tube and drainage tubes, and early postoperativeactivities.Randomized controlled trials and meta-analysis’ show that the skipping absence ofroutine mechanical enema, using epidural anesthesia and analgesia, early removal of thenasogastric tube, and early postoperative daily activities, which are components of FTS, didnot increase incidence of postoperative colorectal surgery complications such as anastomoticleakage, postoperative intestinal obstruction, abdominal infection[32-34]. However, FTS hasnot been adopted in clinical practice in mainland China. One the reasons might be thatChinese physicians are still waiting to be convinced that FTS is better than conventional[35].Randomized controlled trials and meta-analysis mentioned above are mostly based onpatients of Europe and America. Thus, we conducted a randomized controlled study onChinese patients in mainland China.Objective: To compare the outcomes of fast track laparoscopic surgery and conventionallaparoscopic surgery.Method: This study was a prospective, randomized trial.70patients with colorectal cancerunderwent laparoscopic colorectal resection, and were divided into two groups. There were31and39patients in fast-track group and control group, respectively. Protocols for fast-trackgroup included skipping preoperative mechanical bowel preparation, early restoration of dietand early postoperative ambulation. Outcome measures, length of hospital stay, postoperativesurgical stress response (C reactive protein) and postoperative complications were compared between the two groups.Result: The average length of total hospital stay for the fast-track and control group was5.94±0.814d and10.87±1.26d, respectively (P<0.05). The length of postoperative hospitalstay for the fast-track and control group was4.26±0.815d and8.03±1.135d, respectively(P<0.05). First flatus time for the fast-track and the control group was1.58±0.807d and2.49±0.854d, respectively (P<0.05). Defecation time for the fast-track and the control group was2.16±0.735d and4.49±0.683d, respectively (P<0.05). Restoration of solid diet between theFTS group and control group also had a significant difference (1.13±0.341d vs.3.59±0.85d,P<0.05). After surgery, due to postoperative surgical stress, the two groups C-reactive Protein(CRP) levels increased significantly, but the FTS group’s CRP levels were lower than theconventional control group (P<0.05). There is no difference in postoperative complicationbetween the fast-track and the control group.Conclusion: In conclusion, our study, the first one conducted in Chinese patients in China,confirms that fast track surgery shortens patients’ hospital stay and accelerates the recovery ofbowel function without increase of postoperative complication. The fast track surgery is safeimproves postoperative recovery, and offers a better option than conventional laparoscopicsurgery for treating colorectal cancer patients.