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MULTICENTER NATIONAL STUDY  ON FAST TRACK COLORECTAL SURGERY.  PRELIMINARY RESULTS.
 

MULTICENTER NATIONAL STUDY ON FAST TRACK COLORECTAL SURGERY. PRELIMINARY RESULTS.

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    MULTICENTER NATIONAL STUDY  ON FAST TRACK COLORECTAL SURGERY.  PRELIMINARY RESULTS. MULTICENTER NATIONAL STUDY ON FAST TRACK COLORECTAL SURGERY. PRELIMINARY RESULTS. Presentation Transcript

    • Department Colorectal Surgery ZARAGOZA UNIVERSITY HOSPITAL. SPAIN MULTICENTER NATIONAL STUDY ON FAST TRACK COLORECTAL SURGERY. PRELIMINARY RESULTS . JM Ramirez, JA Gracia, P Royo, E Casal-Nuñez, JV Roig, R Cabezali   on behalf of the Spanish working group on fast-track Surgery.
    • Department Colorectal Surgery (1993) Protocol for Colorectal Cancer 1998 Up-dated (Laparoscopic surgery): 2001 2004 2006 2.006: 141 patients (Mean age 69 (43-89))
    • Department Colorectal Surgery (1993) Protocol for Colorectal Cancer 1998 Up-dated (Laparoscopic surgery): 2001 2004 2006 2.006: 141 patients (Mean age 69 (43-89)) *NBCAP (21.356 cases) * National Bowel Cancer Audit Project. ACPGBI. Report 2007 10 29,6 4% Length Hospital stay (mean days) Permanent Stoma rate (PSR) Post-op. Mortality (<30 days) <12 28,3 <5%
      • FAST-TRACK SURGERY :
      • Structured pathway
      Surgical stress reduction Pain relief Fluid therapy Perioperative surgical care (drains, NGT, Bowel clearance, catheters = Hospital stay Morbidity Mortality
    • Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery Henrik Kehlet, Douglas W. Wilmore. Ann Surg 2008;248: 189–198
    • 12 Centres Control Group: Retrospective Study (Six months) Prospective Study: Intention to treat Inclusion criteria: Colorectal cancer Open or Laparocopy Older than 18 y.o. Exclusion criteria: ASA IV Ostomy Previous CRT Madrid, April 2008
    • According to the Best available evidence we will:
      • Avoid Bowel preparation
      • Avoid Drains
      • Avoid NGT
      • Use laparoscopy as much as posible
      • Use transverse incisions
      • Use Epidural anaesthesia (open surgery)
      • Use Warm sheet
      • Use High Oxigenation
      • Have special care in fluid management
      • CardioQ is mandatory
      • Give early oral intake
      • Press for early ambulation
      Madrid, April 2008
    • ON LINE. RECORDING DATA SYSTEM
    • RESULTS From July 2008 to April 2009
    • Retrospective Study 182 patients Mean age 69,6 y.o. ± SD. 13,2 (43-89). Males 61%. 69% 31% Vía abordaje 69% 31% Surgical technique Right colectomy Left Colectomy AR Sigmoidectomy approach Open surgery Lap. Surgery
    • Overall: 34,82% Retrospective Study Mean Stay: 13 days ± SD. 13,731 (4-40) Postoperative morbidity 182 patients Mean age 69,6 y.o. ± SD. 13,2 (43-89). Males 61%. W. Infection Bleeding Death ileus anastomotic leak
    • Early results (135 patients) Prospective Study Mean age 63,4 y.o. ± SD. 10,2 (38-89). Males 60%. Surgical technique
      • Mean Stay: 7 days (3-45)
      Prospective Study Overall: 32 %
    • Prospective Retrospect. Laparosc. Lap. vs Open surgery: 63 p. vs 72 p. (non stat. Diff.) Results
      • Preliminary results
      • Fast Track Spanish Program shorten Hospital Stay by 6 days, without increasing neither morbidity nor mortality
      • At the moment, we have not found differences between open and laparoscopic surgery withina fast track protocol.
      Summary