Fast-track Surgery, A New Concept For Patients Undergoing Laparoscopic Retroperitoneal Radical Nephrectomy For Renal Cell Carcinoma

Purpose: The objective of this study was to evaluate the impact of a multimodal FTS protocols on postoperative recovery and length of hospital stay after laparoscopic retroperitoneal radical nephrectomy.Patients and Methods: 199 patients undergoing laparoscopic retroperitoneal radical nephrectomy received either conventional care or an FTS recovery protocols. The FTS regimen included preoperative consulting and education, preoperative carbohydrate loading before surgery. Oral mechanical bowl preparation and preoperative fasting were abandoned. Pay attention to minimally invasive approach and keep warm intraoperative. Pain management, early oral diet, controlled intravenous infusion, earlier ambulation, remove drainage tube earlier postoperative. Variables were collected, including demographic data, intraoperative characteristics, pain scores, volume of drainage, complications, postoperative hospital stay, and patients’ satisfaction with treatment, et al.Results: Groups were comparable for demographic data and intraoperative characteristics such as operation time, estimated blood loss, intraoperative intravenous infusion(p > 0.05). Patients in group A had a lower pain scores after surgery(Postoperative day 1(POD 1), 2.50 ± 0.91 vs 3.44 ± 0.59, p < 0.05; POD 2, 1.66 ± 1.01 vs 2.52 ± 0.73, p < 0.05; POD 3, 1.04 ± 0.56 vs 1.87 ± 0.70, p < 0.05), earlier drainage removal(3.08±0.79 days vs 3.51±1.38 days, p < 0.05), less intravenous infusion(POD 1, 1112.50 ± 771.2 m L vs 1741.53 ± 553.67 m L, p < 0.05; POD 2, 387.50 ±646.19 m L vs 906.78 ±748.07 m L, p < 0.05; POD 3, 0 m L vs 360.17 ± 623.22 m L, p < 0.05), earlier time to first flatus(1.75 ± 0.65 days vs 2.05 ± 0.75 days, p < 0.05), earlier time to ambulation(0.69 ± 0.47 days vs 2.35 ± 0.48 days, p < 0.05), a shorter postoperative hospitalization(6.55 ± 1.15 days vs 9.57 ± 2.61 days, p < 0.05), and a higher satisfaction with treatment(90.56 ± 3.30 vs 75.78 ± 3.05, p <0.05), but the complications(17(20.99%) vs 26(22.03%), p > 0.05) had no statistical significance between the two groups.Conclusion: With the implication of FTS protocols for laparoscopic retroperitoneal radical nephrectomy, patients can be discharged earlier with lower pain scores, earlier drainage removal, less intravenous infusion, and without sacrificing patients’ safety, which lessened patients’ agony to a large degree during the treatment procedure.