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Does a Combination of Laparoscopic Approach and Full Fast Track Multimodal Management Decrease Postoperative

Léon Maggiori1, Eric Rullier, Jérémie H Lefevre

  • 1*Colorectal Surgery Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Paris VII, Clichy, France †Colorectal unit, Hôpital Haut Lévêque, CHU Bordeaux, University of Bordeaux, Bordeaux, France ‡Digestive Surgery Department, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Pierre & Marie Curie University (Paris VI), Paris, France §Department of Digestive and Oncological Surgery, Amiens-Picardie University Medical Center, Amiens, France ¶Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France ||Department of Digestive and Hepato-Pancreato-Biliary Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Pierre & Marie Curie University (Paris VI), Paris, France **Department of Digestive Surgery, Hôpital Saint-Joseph, Paris, France ††Department of Digestive Surgery, University Hospital of Caen, University of Caen Normandy, Caen, France ‡‡Department of Clinical Research, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University Paris VII, Paris, France.

Annals of Surgery
|August 15, 2017
PubMed
Summary
This summary is machine-generated.

Full fast track multimodal (FFT) management, when combined with laparoscopic colorectal cancer surgery, did not significantly reduce postoperative morbidity compared to limited fast-track (LFT) care. Early catheter removal and absence of intraoperative lidocaine perfusion were key factors in reducing complications.

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Laparoscopic surgery and fast-track protocols are advancements in colorectal cancer treatment.
  • Full fast track multimodal (FFT) management aims to optimize patient recovery post-surgery.

Purpose of the Study:

  • To evaluate if laparoscopic surgery combined with FFT management reduces postoperative morbidity compared to limited fast-track (LFT) care.
  • To compare the efficacy of FFT versus LFT protocols in patients undergoing laparoscopic colorectal cancer surgery.

Main Methods:

  • Randomized controlled trial involving patients undergoing elective laparoscopic colorectal cancer surgery.
  • Patients were assigned to either FFT or LFT care groups, with LFT including early oral intake and mobilization.
  • Primary outcome measured was 30-day postoperative morbidity using the Clavien-Dindo classification.

Main Results:

  • No significant difference in overall 30-day postoperative morbidity between the FFT (35%) and LFT (29%) groups.
  • No significant differences observed in colon or rectal cancer subgroups, nor in severe postoperative morbidity.
  • Independent predictors for reduced morbidity included early (Day 2) intravenous catheter removal and absence of intraoperative lidocaine perfusion.

Conclusions:

  • The addition of FFT multimodal management to laparoscopic colorectal cancer surgery does not decrease postoperative morbidity.
  • Early removal of intravenous catheters and avoiding intraoperative lidocaine perfusion are associated with lower postoperative morbidity.
  • Current FFT protocols may not offer additional benefits over LFT in laparoscopic colorectal cancer surgery regarding morbidity reduction.