Journal of Shandong University (Health Sciences) ›› 2019, Vol. 57 ›› Issue (9): 33-37.doi: 10.6040/j.issn.1671-7554.0.2018.756

Previous Articles     Next Articles

Implementation of enhanced recovery after surgery in abdominoperineal resection of rectal cancer

WANG Haifeng, WANG Gang, ZHAO Jian, LIU Jiang, ZHOU Jiahui, JIANG Zhiwei   

  1. Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu, China
  • Published:2022-09-27

Abstract: Objective To explore the safety and efficacy of enhanced recovery after surgery(ERAS)for patients with rectal cancer treated with abdominoperineal resection(APR). Methods A retrospectivereview of 80 rectal cancer patients who underwent APR at Jinling Hospital during Feb. 2015 and Aug. 2017 was conducted. The patients were divided into ERAS group(n=40)and traditional group(n=40). The postoperative pain, eating time, intestinal function recovery time, ambulation time, stop intravenous infusion time, postoperative hospital stay and postoperative complication in the two groups were observed and compared. Results ERAS group had lower VAS pain score, earlier oral feeding and intestinal function recovery, shorter ambulation and intravenous infusion time, and shorter hospital stay than the traditional group. Postoperative perineal wound complication rate reached 15% in the traditional group, which was significantly higher than the 5% in the ERAS group(P=0.018). Conclusion ERAS is feasible and effective for rectal cancer patients undergoing APR, which can significantly shorten the postoperative hospital stay, and reduce the incidence of perineal wound complications.

Key words: Enhanced recovery after surgery, Rectal cancer, Abdominoperineal resection

CLC Number: 

  • R619
[1] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617.
[2] 江志伟, 李宁, 黎介寿. 加速康复外科的概念及临床意义[J].中国实用外科杂志, 2007, 27(2): 131-133.
[3] Abdikarim I, Cao XY, Li SZ, et al. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas[J]. World J Gastroenterol, 2015, 21(47): 13339-13344.
[4] Bona S, Molteni M, Rosati R, et al. Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience[J]. World J Gastroenterol, 2014, 20(46): 17578-17587.
[5] Keane C, Savage S, McFarlane K, et al. Enhanced recovery after surgery versus conventional care in colonic and rectal surgery[J]. ANZ J Surg, 2012, 82(10): 697-703.
[6] 中国研究型医院学会机器人与腹腔镜外科专业委员会. 胃癌胃切除手术加速康复外科专家共识(2016版)[J]. 中华消化外科杂志, 2017, 16(1): 14-17. Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association. Expert consensus on enhanced recovery after gastrectomy for gastric cancer(2016 edition)[J]. Chinese Journal of Digestive Surgery, 2017, 16(1): 14-17.
[7] 中华医学会肠外肠内营养学分会加速康复外科协作组. 结直肠手术应用加速康复外科中国专家共识(2015)版[J]. 中华胃肠外科杂志, 2015, 18(8): 785-787. China Enhanced Recovery after Surgery Group of Chinese Society for Parenteral and Enteral Nutrition. Chinese consensus of enhanced recovery after surgery for colorectal surgery(2015)[J]. Chinese Journal of Gastrointestinal Surgery, 2015, 18(8): 785-787.
[8] 荚卫东. 加速康复外科多学科团队建设[J]. 中华外科杂志, 2018, 56(1): 14-17. JIA Weidong. Multidisciplinary team building in enhanced recovery after surgery[J]. Chinese Journal of Surgery, 2018, 56(1): 14-17.
[9] 中华医学会外科学分会,中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018)[J]. 中华麻醉学杂志, 2018, 38(1): 8-13. Chinese Society of Surgery, Chinese Society of Anesthesiology. Consensus on ERAS and guidelines for pathway management in China(2018)[J]. Chinese Journal of Anesthesiology, 2018, 38(1): 8-13.
[10] Gritsenko K, Khelemsky Y, Kaye AD. Multimodal therapy in perioperative analgesia[J]. Best Pract Res Clin Anaesthesiol, 2014, 28(1): 59-79.
[11] Rafiq S, Steinbrüchel DA, Wanscher MJ, et al. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trail[J]. J Cardiothorac Surg, 2014, 9: 52. doi: 10.1186/1749-8090-9-52.
[12] 高建军, 孙纲, 李明, 等. 折刀位经腹会阴联合直肠癌根治术[J].临床军医杂志, 2012, 40(2): 451-453.
[13] Holm T, Ljung A, Hiiggmark T, et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer[J]. Br J Surg, 2007, 94(2): 232-238.
[14] Dinaux AM, Amri R, Berger DL. Prone positioning reduces perineal infections when performing the miles procedure[J]. Am J Surg, 2017, 214(2): 217-221.
[15] Showalter SL, Kelz RR, Mahmoud NN. Effect of technique on postoperative perineal wound infections in abdominoperineal resection[J]. Am J Surg, 2013, 206(1): 80-85.
[16] 鲍扬, 江志伟, 王刚, 等. 腹腔镜联合折刀位直肠癌腹会阴根治术[J]. 腹腔镜外科杂志, 2011, 16(10): 752-754. BAO Yang, JIANG Zhiwei, WANG Gang, et al. Laparoscopic Miles operation with jackknife position for low rectal carcinoma[J]. Journal of Laparoscopic Surgery, 2011, 16(10): 752-754.
[17] Liu P, Bao H, Zhang X,et al. Better operative outcomes achieved with the prone jackknife vs. lithotomy position during abdominoperineal resection in patients with low rectal cance[J]. World J Surg Oncol, 2015, 13: 39. doi: 10.1186/s12957-015-0453-5.
[1] LI Ziqi, WEI Yanruoxue, LIU Xiaohan, LIU Chuncheng, ZHAO Ran, LIU Yukun. The functional role and clinical significance of lncRNA HEATR3-AS1 in colorectal cancer tumorigenesis and progression [J]. Journal of Shandong University (Health Sciences), 2025, 63(9): 108-115.
[2] DU Xue, LI Chunxia, LIU Yunxia, ZHANG Tao. Dynamic prediction model for the colorectal cancer patients prognosis based on MFPC-Cox [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 101-110.
[3] HU Bingtao, ZHANG Wencan, WANG Chongyi, LIN Xiangyu, WANG Kaibin, FENG Yunze, LIU Chen, XU Wanlong, LI Le, SI Haipeng. Clinical analysis of one-hole split endoscope for lumbar spinal stenosis based on enhanced recovery after surgery [J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 1-7.
[4] MA Zhihu, YU Xiaofeng, SUN Yuliang, WANG Gang, PEI Yantao, CHEN Bin, SHI Anhao, QIAO Li, ZHU Lei. Application of enhanced recovery after surgery comprehensive treatment in the perioperative period of patients with triangular fibrocartilage complex injuries [J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 28-35.
[5] WANG Gang, XU Pengyan, ZHAO Xuan, WANG Haifeng, GE Miaomiao, PAN Huafeng, JIANG Zhiwei. Effect of ω-3 polyunsaturated fatty acids on recovery of autonomic nervous system and intestinal function after laparoscopic colorectal cancer surgery [J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 36-42.
[6] CUI Qianqian, LI Jinpeng, WU Yudan, HOU Zhiping, SUN Weiluo, CUI Panpan, HE Peiyuan. Clinical value of fecal miRNA for non-invasive screening of advanced colorectal adenomas [J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 43-50.
[7] CHANG Yu, HU Yunfeng, WANG Huifeng, GUO Jing, ZHANG Tiao, HAO Yaqin, LIU Yu. A mendelian randomization study on the association between appendectomy and the risk of colorectal cancer [J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 77-83.
[8] YU Jing, WANG Gang, WANG Ye, SHAO Mingyue, PAN Huafeng, GE Miaomiao, WANG Haifeng, JIANG Zhiwei. Effect of Yiqidaozhi Decoction in postoperative intestinal recovery of colorectal cancer patients based on I-FEED scoring system [J]. Journal of Shandong University (Health Sciences), 2025, 63(12): 35-43.
[9] WANG Xiao, KONG Wenru, CUI Weiliang, WANG Shuqi. Alstonia mairei total alkaloids enhance the sensitivity of colorectal cancer to 5-fluorouracil chemotherapy [J]. Journal of Shandong University (Health Sciences), 2024, 62(6): 30-37.
[10] WEI Yanruoxue, LI Ziqi, LIU Chuncheng, LIU Xiaohan, ZHAO Ran, LIU Yukun. Intratumor heterogeneity of SP1 expression in colorectal cancer and its clinical significance [J]. Journal of Shandong University (Health Sciences), 2024, 62(5): 89-94.
[11] LIU Chuncheng, LIU Xiaohan, WEI Yanruoxue, LI Ziqi, LIU Yukun, ZHAO Ran. Subcellular localization pattern of bromodomain containing 9 in colorectal cancer and its clinical significance [J]. Journal of Shandong University (Health Sciences), 2024, 62(4): 24-30.
[12] SI Haipeng, WANG Chongyi, GONG Guiqing, ZHANG Wencan, GUO Yingjun, WANG Kaibin,FENG Yunze, XU Wanlong, LI Le. Application progress of enhanced recovery after surgery in spine surgery [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 8-17.
[13] ZHANG Yang, LI Xiaoxu. Research progress of enhanced recovery after surgery for fracture treatment [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 18-25.
[14] FENG Chang, GUO Yan, ZHAO Jie, ZHAO Xin. Research progress in ultrasound-guided regional block in orthopaedic surgery under the concept of ERAS [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 26-35.
[15] JIANG Rendong, ZHAO Jianli, SHI Chao, HE Yeteng, YUAN Zhen. Clinical outcomes comparison of total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis under the concept of enhanced recovery after surgery [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 62-67.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!