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

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  • 1. 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.
  • 2. 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))
  • 3. 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%
  • 4.
    • FAST-TRACK SURGERY :
    • Structured pathway
    Surgical stress reduction Pain relief Fluid therapy Perioperative surgical care (drains, NGT, Bowel clearance, catheters = Hospital stay Morbidity Mortality
  • 5. Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery Henrik Kehlet, Douglas W. Wilmore. Ann Surg 2008;248: 189–198
  • 6. 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
  • 7. 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
  • 8. ON LINE. RECORDING DATA SYSTEM
  • 9. RESULTS From July 2008 to April 2009
  • 10. 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
  • 11. 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
  • 12. Early results (135 patients) Prospective Study Mean age 63,4 y.o. ± SD. 10,2 (38-89). Males 60%. Surgical technique
  • 13.
    • Mean Stay: 7 days (3-45)
    Prospective Study Overall: 32 %
  • 14. Prospective Retrospect. Laparosc. Lap. vs Open surgery: 63 p. vs 72 p. (non stat. Diff.) Results
  • 15.
    • 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