Neoplasms

Digestive System Diseases

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Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

fast-track rehabilitation with early ambulation and diet after elective colorectal resection

fast-track rehabilitation

Sung-Bum Kang, M.D., Ph.D

The purpose of this study is to address the question of whether or not oral alimentation and ambulation exercise should be begun early in patients following laparoscopic colorectal surgery compared to the classical diet and ambulation which depends on reappearance of functional intestinal transit. Early oral alimentation following laparoscopic colorectal surgery may decrease hospital stay and facilitate earlier discharge with comparable postoperative morbidity.

Traditionally, patients who received laparoscopic colorectal surgery were treated with the classical protocol including the use of a naso-gastric tube and starvation for several postoperative days till the recovery of bowel movement, or bed resting at immediate postoperative period followed by ward ambulation at the postoperative day 1 or 2. Restarting the oral alimentation is based on gas or feces reappearance after surgery and usually this is possible at several days following surgery. However, prolonged starvation might be uncomfortable for the patient as well as increasing his postoperative hospital stay. Recently, several studies reported the efficacy of early rehabilitation protocols after intestinal surgery, showing that early oral alimentation could reduce the length of hospital stay and cost of hospitalization without significant increase of postoperative complications, compared to traditional management.

This prospective, randomized study was designed to evaluate the effectiveness of a postoperative care pathway using rehabilitation with early ambulation and diet for patients undergoing elective laparoscopic colorectal resection compared with the traditional postoperative care.

In order to conduct this study, patients having a laparoscopic colon resection will be randomly attributed to enhanced recovery program group or control group, which is divided based on the postoperative management protocol.

Fast-track Rehabilitation After Elective Colorectal and Small Bowel Resection

Randomized Controlled Trial of Fast-Track Rehabilitation After Elective Colorectal and Small Bowel Resection

discharge criteria

1. Tolerance of consecutive 3 soft bland diet
2. Unassisted ambulation
3. No necessity of analgesics
4. Afebrile without major complication
5. Willing to discharge

score measured by the Visual Analog Scale

recovery criteria must include all of the following

1. Tolerance of consecutive 3 soft bland diet
2. Unassisted ambulation
3. No necessity of analgesics
4. Afebrile without major complication

Seoul National University Hospital

Associate Professor Department of Surgery, Seoul National University Bundang Hospita

Control Group

Early rehabilitation program after laparoscopic colon surgery with early oral alimentation and early ambulation

ERP Group

Total

Age, Categorical

Age Continuous

Sex: Female, Male

Korea, Republic of

Region of Enrollment

Sung-Bum Kang

Early rehabilitation program after laparoscopic colorectal surgery with early oral alimentation and early ambulation

1 mortality case was excluded for analysis in the ERP group

the Length of Hospital Stay

Pain

Quality of Life

Postoperative Complication During the First Admission

Recovery

Readmission Rate

Postoperative Complication

Overall Study

Colonic Neoplasms

Anti-Infective Agents

All Drugs and Chemicals

Herbal and Botanical

Anti-Bacterial Agents

Antibiotics, Antitubercular

Cola

early recovery program with no preoperative mechanical bowel preparation, early diet initiation, and prevention of postoperative ileus after elective laparoscopic colon cancer surgery

Traditional, conventional perioperative treatment

Enhanced recovery program day-1: no mechanical bowel preparation, intake permit until 6 hrs before operation day0: operation, postoperative fluid therapy, antibiotics day1: liquid diet, early ambulation, removal of foley catheterization day2-3: soft diet day 4-5: discharge

Enhanced recovery program

Gyu-Seog Choi, MD

An enhanced recovery program has been developed to provide for colon cancer patients faster and more personalized postoperative treatment. Most of the previous studies have showed that the efficacy of the enhanced recovery program on both subjective and objective physical recovery of patients. However, such studies are rarely conducted in South Korea. The purpose of this study is to evaluate the feasibility and efficacy of a postoperative enhanced recovery program in patients who underwent laparoscopic colon cancer surgery at a tertiary hospital in Korea.

Enhanced Recovery Program After Laparoscopic Colon Cancer Surgery

Implementation of an Enhanced Recovery Program After Laparoscopic Colon Cancer Surgery

Duration of hospital stay from the date of operation to the date when a patient meets the following "discharge criteria".

Discharge criteria:

* Tolerance of consecutive 3 soft diet
* Recovery of bowel function (without PONV)
* No necessity of intravenous analgesics
* Stable vital sign (afebrile)

Body weight, body mass index, body composition, before and after surgery

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Fast-track Rehabilitation After Elective Colorectal and Small Bowel Resection	NCT00606944	Colorectal Tumo...	fast-track reha...	20 Years - 80 Years	Seoul National University Hospital
Fast-track Rehabilitation After Elective Colorectal and Small Bowel Resection	NCT00606944	Colorectal Tumo...	fast-track reha...	20 Years - 80 Years	Seoul National University Hospital
Enhanced Recovery Program After Laparoscopic Colon Cancer Surgery	NCT02399631	Colon Cancer	Enhanced recove...	20 Years - 80 Years	Kyungpook National University Hospital

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