Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial

Abstract

Although early rehabilitation programs have been reported to be effective after laparoscopic colectomy, there is no report of the efficacy of rehabilitation programs after rectal cancer surgery. This study was designed to evaluate the efficacy of an early rehabilitation program after laparoscopic low anterior resection for mid or low rectal cancer in a randomized, controlled trial. Ninety-eight patients who had undergone a laparoscopic low anterior resection with defunctioning ileostomy were randomized on a 1:1 basis to an early rehabilitation program (n=52) or conventional care (n=46). The primary endpoint was recovery rate at 4days postoperatively. The secondary endpoints were recovery time, postoperative hospital stay, complications, readmission rates, pain on a visual analogue scale, and quality of life (QOL) according to Short Form 36. The recovery rates were not different in both groups (rehabilitation, 25% vs. conventional, 13%, p=0.135). Recovery time and postoperative hospital stay was similar between the groups (rehabilitation, 137h [107-188] vs. conventional, 146.5h [115-183], p=0.47; 7.5days [7-11] vs. 8.0days [7-10], p=0.882). The complication rates did not differ between the two groups, but more complications were noted in the rehabilitation program group (42.3 vs. 24.0%, p=0.054), which was related to postoperative ileus (28.8 vs. 13.0%, p=0.057) and acute voiding difficulty (19.6 vs. 4.7%, p=0.032). There was no readmission within 1month of surgery. Pain and QOL were similar in both groups. This randomized trial did not show that an early rehabilitation program is beneficial after laparoscopic low anterior resection. Our results confirm that postoperative ileus and acute voiding difficulty are major obstacles to fast-track surgery for mid or low rectal cancer. This study was registered (registration number NCT00606944).