Fast-track Surgery Program Research Articles

Modification of fast-track surgery during partial nephrectomy

The present study aimed to assess the efficacy of the multimodal fast-track surgery (FTS) program supplemented with the exclusion of renal thermal ischemia, urinary tract drainage, and postoperative wound management in patients undergoing partial nephrectomy for localized T1 RCC.
 Methods. A total of 150 patients diagnosed with localized RCC in stage T1 N0 M0 were initially enrolled in this prospective randomized study, with 75 patients assigned to each study group. Patients undergoing perioperative management following the FTS program were randomly assigned to the main study group. The control group comprised patients receiving standard postoperative care. The study specifically involved patients with kidney neoplasms not exceeding 7 cm in the largest diameter based on computed tomography data. Tumor size, localization, and the volume of functioning parenchyma were considered in the assessment.
 Results. Among the patients included, 24 cases (16%) underwent radical nephrectomy due to technical difficulties arising from tumor spread to the kidney hilum, rendering them ineligible for further analysis. Consequently, the clinical analysis focused on 126 patients. Within the main group, 64 cases (50.8%) of RCC underwent randomization, and the multimodal FTS program was applied during partial nephrectomy. The control group comprised 62 patients (49.2%).
 The median postoperative bed day in the main group was 1.5 days less compared to the control group, with values of 3.2 [2; 4] days versus 5 [4; 7] days, respectively (p < 0.001). Intraoperative complications occurred in 5 cases (4.0%) involving blood loss exceeding 1 liter (4 cases in the main group and 1 case in the control group). Transfusion of blood components occurred only once when the hemoglobin level dropped below 70 g/l.
 In the early postoperative period, a total of 9 complications (7.1%) were observed with pyelonephritis lasting more than 3 days diagnosed in 4 cases (3.2%) and wound suppuration in 1 case (0.8%). Despite the absence of drainage in postoperative wounds within the main group, ultrasound examinations revealed small retroperitoneal hematomas (up to 100 ml) requiring drainage in 3% of cases.
 Conclusions. The multimodal FTS program for patients with localized RCC during partial nephrectomy, coupled with the exclusion of central thermal ischemia of the kidney, avoidance of retroperitoneal space drainage, and early patient activation, demonstrated a significant reduction in postoperative bed while maintaining a comparable level of perioperative complications.

Accompanying Therapy in the Surgical Treatment of Pathological Fractures of the Long Bones and Chronic Fractures of the Trochanteric Region

The article presents a study of palliative surgical treatment of patients with pathological fractures of the long bones and chronic trochanteric fractures. Those patients are not indicated for special oncological treatment. Therefore, the article does not provide staging of malignant neoplasms. The surgical treatment was aimed at improving the quality of life of palliative patients, and accompanying therapy in the form of the Altaicae extract adaptogen and the neutral anolyte led in our study to an increase in the effectiveness of surgical treatment of such a severe contingent of patients.INTRODUCTION According to domestic and foreign literature, the number of oncological diseases in young and old people is growing. There is a trend to neglecting the disease and late visits to doctors. Almost all types of cancer of various localization and other malignant tumors metastasize to the bones. An increase in the number of pathological (metastatic) fractures of the trochanteric region and the long bones was also noted. Surgical treatment of patients with such a severe type of fractures leads to an aggravation of the already existing immunodeficiency and, as a rule, creates the prerequisites for the occurrence of infectious complications in the postoperative period. The choice of a conservative method of treatment often does not justify itself as well, it leads to diagnostic and therapeutic errors, and in the future — to chronic pathological fractures.AIM To improve the effectiveness of surgical treatment and the quality of life of palliative patients with pathological (metastatic) fractures of the long bones and chronic trochanteric fractures using original authors’ accompanying therapy.MATERIAL AND METHODS 177 patients were examined and divided into two groups the main and the control groups. 72 patients were included in the main group, and 105 patients in the control group. There were 110 men and 67 women. The patient age ranged from 35 to 90 years. The main group received surgical treatment with the use of new accompanying therapy along with the basic one, and the control group received only surgical treatment and basic therapy.RESULTS In the main group patients with chronic pathological fractures of the trochanteric region, who underwent endoprosthetic replacement, osteosynthesis, a new method of surgical treatment of metastatic fractures of the long bones and the authors’ accompanying therapy, the effectiveness of surgical treatment increased significantly compared to the comparison group. As a result, most of the unwanted symptoms disappeared, time spent in hospital decreased, the psychoemotional status and immunity improved, the functional state of the body was optimized, and the quality of life improved.CONCLUSION The use of new accompanying therapy, the authors’ method of surgical treatment of patients with pathological (metastatic) fractures of the long bones, chronic fractures of the trochanteric region allows us to successfully and effectively operate on such severe patients and perform a fast track surgery program in the early postoperative period.

The safety of neoadjuvant chemotherapy combined with non-tube nofasting fast-track surgery for esophageal carcinoma.

Our non-tube no fasting (early oral feeding and no nasogastric tube) fast-track surgery (FTS) was safe and effective to combine with neoadjuvant chemotherapy for McKeown minimally invasive esophagectomy. In addition, the two groups were similar in terms of the recovery time, hospital discharge day, and early resumption of oral feeding.ObjectivesTo evaluate the safety of early oral feeding (EOF) combined with neoadjuvant chemotherapy (NAC) of esophagectomy.Summary Background DataOur non-tube no fasting (early oral feeding and no nasogastric tube) fast-track surgery (FTS) was safe and effective for primary surgery esophageal cancer patients.MethodsWe retrospectively evaluated consecutive patients who underwent non-tube no fasting and McKeown minimally invasive (MIE). They were divided into two groups: one received NAC, and the other received primary surgery. Complications after the operation, postoperative CRG complications, operative time, operative bleeding, and length of stay were evaluated.ResultsBetween 01/2014 and 12/2017, there hundred and eighty two consecutive patients underwent MIE with total two-field lymphadenectomy under the non-tube no fasting fast-track surgery program. A total of 137 patients received NAC, and 245 accepted primary surgery. Propensity score matching was used to compare NAC patients with 62 matched patients from each group. The NAC group had a similar number of total complications as the primary surgery group (32.26% in the primary surgery group vs. 25.81% in the NAC group; p=0.429) and had the same median postoperative hospitalization duration (8 days, p=0.723).ConclusionsAfter McKeown MIE, the patients receiving NAC combined with “non-tube no fasting” FTS had a similar incidence of postoperative complications outcomes as those without NAC. In addition, the two groups were similar in terms of the recovery time, hospital discharge day, and early resumption of oral feeding.

A fast-track surgery programme leads to timelier treatment and higher resection rates in pancreatic cancer.

The aim was to perform a propensity-matched comparison of patients with pancreatic cancer undergoing surgery, with and without biliary stenting and an intention to treat analysis of long-term survival between the two groups. This was an observational study of a cohort of consecutive patients presenting with obstructive jaundice and undergoing pancreatoduodenectomy for pancreatic and periampullary malignancies between November 2015 and May 2019. In this study of 216 consecutive operable patients, 70 followed the fast-track pathway and 146 had pre-operative biliary drainage. All 70 patients in the FT group and 122 out of 146 in the PBD group proceeded to surgery (100% and 83.6% respectively, p=0.001). Interval time from diagnostic CT scan to surgery and from MDT decision to treat to surgery was shorter in the FT group, (median 8 vs 43 days p<0.001 and 3 vs 36 days p<0.001 respectively) as was the overall time from diagnostic CT to adjuvant treatment (88 vs 121 days p<0.001). Postoperative outcomes including complications, readmission and mortality rates were comparable in the two groups. There was no difference in survival. For a person with pancreatic cancer who is proceeding to surgery, the best approach is to avoid pre-operative biliary drainage.

Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions

BackgroundFast-track hip and knee arthroplasty (HA and KA) has been increasingly common over the last decade. In the same time period, there was a strong trend toward less restrictive mobilization. However, few reports have been published on combining these novel programs while measuring the postoperative results by patient-reported outcome measures (PROMs). Descriptions of fast-track surgery programs and their results are warranted.MethodsThe aim of this retrospective cohort study was to examine if it is possible to achieve excellent PROM results for hip and knee arthroplasty patients in a fast-track pathway without postoperative restrictions. During 2014–2017, the stepwise introduction of a PROM program was implemented at Stavanger University Hospital for all scheduled HA and KA patients, with preoperative assessments and postoperative follow-ups at the outpatient clinic. Standardized information with a focus on early mobilization and no postoperative restrictions was also initiated for the same patients. The generic EuroQol questionnaire (EQ-5D) and either the Hip or Knee disability/injury and Osteoarthritis Outcome Score (HOOS or KOOS) were used.ResultsPROM response rates varied from 80 to 99%. The median (interquartile range) change from preoperative to one-year postoperative results were as follows for HA and KA patients, respectively: pain, 55 (43–68) and 47 (31–61); other symptoms, 50 (40–65) and 36 (19–50); function in daily living, 54 (41–65) and 44 (31–55); function in sports and recreation, 56 (38–75) and 40 (15–64); joint-related quality of life, 69 (50–81) and 56 (38–75). The length of stay (LOS) was reduced by 1.9 days (mean), corresponding to a 40% reduction for HA patients and a 37% reduction for KA patients.ConclusionsWe found excellent PROM results after fast-track HA and KA with no postoperative restrictions. We believe that a fast-track program focusing on mobilization without any postoperative restrictions is superior for most patients, but further comparative studies are warranted.

Effectiveness of the Fast Track Surgery Program for Patients with Planned Cholecystectomy.

This study analyzed the effectiveness of minimizing surgical trauma, reducing the severity of the stress reaction, and restoring the normal functioning of the body after planned gallbladder operations under an enhanced recovery program. This prospective comparison study included 30 patients from the surgical department of Irkutsk Clinical Hospital No. 1 who had been diagnosed with cholelithiasis in 2019-2020. All 30 patients completed the study and were randomly assigned to one of two groups: the FTS group (group I, n = 15) and the standard group (group II, n = 15). The comparison groups were statistically homogeneous in terms of preoperative parameters. All patients underwent prescribed surgeries. In the early and late postoperative period, there were no cases of mortality or significant complications. A comparison of the groups with respect to the effectiveness of treatment according to established criteria showed good treatment results for 13 (86.6%) patients in group I and 2 (13.3%) patients in group II (p = 0.016). The FTS treatment protocol was a significant predictor of treatment success (OR 3.1; 95% CI 0.2; 6.0; p = 0.033). The fast track surgery protocol gave superior results for surgical treatment in comparison with the standard protocol in patients with cholelithiasis.

A Fast-Track Surgery Programme Leads to Timelier Treatment and Higher Resection Rates in Pancreatic Cancer

Introduction: The aim of this study was to perform a propensity-matched comparison of patients with pancreatic cancer undergoing surgery, with and without biliary stenting, to examine perioperative outcomes and to perform an intention to treat analysis to evaluate long-term survival between the two groups. Methods: This was an observational study of a cohort of consecutive patients presenting with obstructive jaundice and undergoing pancreatoduodenectomy for pancreatic and periampullary malignancies between November 2015 and May 2019. Results: In this retrospective study of 216 consecutive operable patients, 70 followed the fast-track (FT) pathway and 146 had pre-operative biliary drainage (PBD). All patients in the fast-track group and 122 out of 146 in the PBD group proceeded to surgery (100% and 83.6% respectively, p=0.001). Interval time from diagnostic CT scan to surgery and from MDT decision to treat to surgery was much shorter in the FT group (median range) 8 vs 43 days p<0.001 and 3 vs 36 days p<0.001 respectively) as was the overall time from diagnostic CT to adjuvant treatment (88 vs 121 days p<0.001). Postoperative outcomes including in-hospital stay, number and grading of complications, readmission rate and mortality rates were comparable in the two groups. There was no difference in survival between the two groups. Conclusion: These data strengthen the existing evidence that, for a person with pancreatic cancer who is proceeding to surgery, the best approach is to avoid pre-operative biliary drainage. The optimal comparison to the neoadjuvant approach is upfront fast-track surgery without biliary drainage followed by adjuvant therapy.

O-P02 A fast-track surgery programme leads to timelier treatment and higher resection rates in pancreatic cancer

Abstract Background Pancreatic cancer is currently the fourth most common cause of cancer-related mortality in the economically developed world and is set to become the second most common cause of cancer-related mortality within the next few years. NICE guidance makes a strong recommendation to offer up-front surgery to people with resectable pancreatic cancer, without preoperative biliary drainage, if sufficiently fit for surgery. The aim of this study was to perform a propensity-matched comparison of patients with pancreatic cancer undergoing surgery, with and without biliary stenting, to examine perioperative outcomes and to perform an intention to treat analysis to evaluate long-term survival between the two groups. Methods This was an observational study of a cohort of consecutive patients presenting with obstructive jaundice and undergoing pancreatoduodenectomy for pancreatic and periampullary malignancies between November 2015 and May 2019. Data related to patient and tumour characteristics, biliary drainage, surgery and histopathology were gathered and analysed from a prospectively maintained electronic database. Post-operative complications were defined and graded according to the definitions of the International Study Group on Pancreatic Surgery (ISGPS) and the Clavien-Dindo system. Data related to adjuvant treatment, disease recurrence and overall survival were also analysed. Results In this retrospective study of 216 consecutive operable patients, 70 followed the fast-track (FT) pathway and 146 had pre-operative biliary drainage (PBD). All 70 patients in the fast-track group and 122 out of 146 in the PBD group proceeded to surgery (100% and 83.6% respectively, p = 0.001). Interval time from diagnostic CT scan to surgery and from MDT decision to treat to surgery was much shorter in the FT group (median range) 8 vs 43 days p &amp;lt; 0.001 and 3 vs 36 days p &amp;lt; 0.001 respectively) as was the overall time from diagnostic CT to adjuvant treatment (88 vs 121 days p &amp;lt; 0.001). Postoperative outcomes including in-hospital stay, number and grading of complications, readmission rate and mortality rates were comparable in the two groups. There was no difference in survival between the two groups. Conclusions These data strengthen the existing evidence that, for a person with pancreatic cancer who is proceeding to surgery, the best approach is to avoid pre-operative biliary drainage. The optimal comparison to the neoadjuvant approach is upfront fast-track surgery without biliary drainage followed by adjuvant therapy.

Knee Scores of Patients with Non-Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed-Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial.

ObjectiveTo evaluate knee scores and clinical efficacies of patients with non‐lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile‐bearing (MB) unicompartmental knee arthroplasty (UKA), fixed‐bearing (FB) UKA, and total knee arthroplasty (TKA).MethodsFrom September 2015 to February 2017, a prospective, randomized, parallel, single‐center trial of 180 patients (78 males and 102 females; 63.3 ± 6.9 years) with non‐lateral compartmental knee OA was performed in the first author‐affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast‐track surgery program was carried out for all patients. The knee scores at 3‐year follow‐up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared.ResultsPrimarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3‐year follow‐up (123.0° > 96.0°) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0° > 96.0°) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group.ConclusionUKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non‐lateral compartmental knee OA.

A fast-track surgery program leads to timelier treatment and higher resection rates in pancreatic cancer

A fast-track surgery program leads to timelier treatment and higher resection rates in pancreatic cancer

The fast-track surgery program application after pancreaticoduodenectomy, using interintestinal anastomosis in accordance to Brown procedure

Objective. To estimate the impact of formation of gastroenteroanastomosis with Brown’s anastomosis, while performing of pancreatico-duodenectomy, on the gastric evacuation arrest rate in a frame of the fast-track surgery program implementation.&#x0D; Materials and methods. To the investigation 92 patients, ageing 28 -75 yrs old, were included, to whom pancreaticoduodenectomy for benign and malignant pancreatic and peripancreatic zone pathology was performed in Jan. 2015 - Aug. 2020 yrs. Perioperative treatment was conducted in accordance to the fast-track surgery program. The first Group consisted of 60 patients, in whom reconstruction in accordance to Child was done, and the second Group - of 32 patients, in whom gastroenterostomy with anastomosis in accordance to Brown procedure was performed.&#x0D; Results. In the Group I complications have had occurred in 16 (26.7%) patients, in the Group II - in 7 (21.9%), in Group I there were 22 complications, in the Group II - 10, but trustworthy difference between the Groups in accordance to these indices was absent (p &gt; 0.05). Analysis of parameters for restoration of peroral feeding have shown enhanced susceptibility of the program in patients of Group II. The rate of the gastric evacuation arrest in first Group of patients have exceeded the analogous index in patients of Group II in 2 times - 13.3 and 6.3%, accordingly, but statistically significant difference between the Groups in accordance to this index was absent (p = 0.299).&#x0D; Conclusion. While formation of gastroenteroanastomosis with anastomosis in accordance to Brown procedure in pancreatico-duodenectomy the implementation level for the fast-track surgery program raises and the rate of gastric evacuation arrest diminishes.

Nasogastric Decompression vs No Decompression After Pancreaticoduodenectomy

Although standardization of pancreaticoduodenectomy (PD) has improved postoperative outcomes, morbidity remains high. Fast-track surgery programs appear to improve morbidity, and avoiding nasogastric tube decompression (NGTD), already outdated in most major abdominal surgery, is strongly suggested after PD by fast-track surgery programs but lacks high-level evidence, especially regarding safety. To assess in a randomized clinical trial whether the absence of systematic NGTD after PD reduces postoperative complications. The IPOD study (Impact of the Absence of Nasogastric Decompression After Pancreaticoduodenectomy) was an open-label, prospective, single-center, randomized clinical trial conducted at a high-volume pancreatic surgery university hospital in France. In total, 155 patients who were 18 to 75 years of age and required PD for benign or malignant disease were screened for study eligibility. Key exclusion criteria were previous gastric or esophageal surgery and severe comorbidities. Patients were randomly assigned (1:1) to systematic NGTD or to no nasogastric decompression and were followed up until 90 days after surgery. For patients without NGTD, the NGT was removed immediately after surgery, whereas for patients with NGTD, the NGT was removed 3 to 5 days after surgery. The primary end point was the occurrence of postoperative complications grade II or higher using the Clavien-Dindo classification. The primary end point and safety were evaluated in the intent-to-treat population. From January 2016 to August 2018, 125 screened patients were considered eligible for the study, and 111 were randomized to no NGTD (n = 52) or to NGTD (n = 59). No patient was lost to follow-up. The 2 groups had similar patient demographic and clinical characteristics at baseline. The median (interquartile range) age was 63.0 (57.0-66.5) years in the group with NGTD (38 [64.4%] were males) and 64.0 (58.0-68.0) years in the group without NGTD (31 [59.6%] were males). The postoperative complication rates grade II or higher were similar between the 2 groups (risk ratio, 0.99; 95% CI, 0.66-1.47; P > .99). Pulmonary complication rates (risk ratio, 0.59; 95% CI, 0.18-1.95; P = .44) and delayed gastric emptying rates (risk ratio, 1.07; 95% CI, 0.52-2.21; P > .99) were not significantly different between the groups. Median (interquartile) length of hospital stay for patients without NGTD was not significantly different compared with those with NGTD (10.0 [9.0-16.3] vs 12.0 [10.0-16.0] days; P = .14). The present study found no significant difference in postoperative complication occurrence of Clavien-Dindo classification grade II or higher between systematic NGTD and no NGTD after PD, suggesting that avoiding systematic nasogastric decompression is safe for this indication. ClinicalTrials.gov Identifier: NCT02594956.

Fast Track Program in Conversion Bariatric Surgery, as Safe as in Primary Bariatric Surgery?

Evaluate the safety of fast track (FT) surgery program in patients undergoing primary and revisional bariatric surgery (conversion from one procedure to another); identify limiting factors for early discharge and predictive factors for readmission. This is a retrospective review of 730 consecutive morbidly obese patients who underwent bariatric surgery between January 2016 and December 2017. Fast track protocol was applied on all patients. Target discharge was after one-night stay. The primary end point is length of stay. The secondary end point is frequency of hospital contact after discharge, readmissions and reinterventions within 30 days. Primary procedures (n = 633) were banded Roux-en-Y gastric bypass (BRYGB, 79.3%), sleeve gastrectomy (10.7%), gastric band (4.7%) and others (5.3%). Mean age (± SD) was 44.32 ± 11.26 years, and mean BMI (± SD) was 43.58 ± 6.12 kg/m2. Conversion procedures (n = 97) were gastric band to BRYGB (40.2%), or to adjustable BRYGB (39.2%), Mason to BRYGB (11.3%), sleeve to BRYGB (4.1%) and others (5.2%). Mean age (± SD) was 47.22 ± 9.1 years, and mean BMI (± SD) was 37.9 ± 7.27 kg/m2. Mean LOS in primary patients was 1.3 ± 0.99, and that in conversion patients was 1.5 ± 1.4. Successful discharge at one night or less was achieved in 650 cases (573 primary and 77 conversion). After one-night discharge, incidence of contact to the hospital, readmission and reintervention was 23.9%, 5.9% and 1.9%, in the primary group and 31.2%, 13% and 5.2% in the conversion group. One-night discharge in FT managed conversion procedures is safe, compared to primary procedures. It is associated with higher readmission rates; however, the postdischarge hospital contacts and surgical complications were not statistically significant different.

Application of principles of multimodal analgesia as the content element of a fast-track surgery program

Objective. To estimate the efficacy of postoperative pain reduction in first days after surgical intervention in acceleration of postoperative restoration in patients and reduction of the stationary treatment duration.&#x0D; Materials and methods. In Sept. 2011 - May 2019 yrs period there were performed 569 elective operative interventions, using principles of a Fast Track Surgery program, including those with application of multimodal analgesia. Depending on the kind of operative intervention the indices of pain impulses were determined in accordance to visual-analogous scale and median duration of stationary treatment.&#x0D; Results. On the first day after laparoscopic cholecystectomy the pain impulsation level have constituted 2.87 ± 0.74, on the second day - 2.01 ± 0.50 (p &lt; 0.001). Median duration of the patients’ stationary stay have constituted 1.72 days. After laparoscopic hernioplasty the results of the pain level investigation were: on the first day - 3.44 ± 0.67, on the second day - 2.06 ± 0.51 (p &lt; 0.001). Median duration of postoperative treatment have constituted 1.43 days. After laparoscopic bariatric interventions on large bowel during the first postoperative day the pain level have constituted 4.24 ± 0.75 and 4.39 ± 0.84 accordingly, on the second day it have reduced to 3.48 ± 0.57 (p &lt; 0.001) and 3.48 ± 0.77 (p &lt; 0.001), on the third day - to 2.79 ± 0.67 (p &lt; 0.001) and 2.84 ± 0.69 (p &lt; 0.001). At the same time a median duration of the patients’ stationary stay have constituted (4.99 ± 0.45) and (4.10 ± 0.60) days, accordingly.&#x0D; Conclusion. Efficacy of reduction of postoperative pain in first days after surgical intervention immediately impacts the speed of restoration of the patients’ organism and duration of stationary treatment.

Fast-Track Approach for Breast Reconstructive Surgery in Patients With Breast Cancer.

Aim:The aim of this study was to develop and implement the concept of fast-track surgery (FTS) for reconstructive breast surgery in patients with breast cancer (BC) to improve early and long-term results of treatment.Materials and methods:The study includes 749 patients with stage 1 to 3 BC. A total of 253 patients with BC got treatment according to FTS program and were included to the core group. Other 496 patients with BC (control group) were not included to the FTS program. Patients were treated from December 2010 to December 2014. All age groups were covered (18-70 years old).Results:There was a significant difference in the average length of hospital stay (LOS) which was 14.27 ± 7.00 days in the core group and 20.11 ± 7.70 days in the control group (P < .001). In advanced BC cases in the core group, LOS was >8 days lower comparing with the control group on average. The LOS in patients who underwent adjuvant chemotherapy was 2.7 times lower in the FTS group comparing with the control group.Conclusions:The study results allow us to recommend the concept of FTS for implementation in broad medical practice for breast reconstructive surgery in patients with BC. The FTS program was shown to be effective in all types of breast surgery, including immediate oncoplastic and reconstructive surgeries. The gradual reduction of LOS increased the number of surgeries in our department by 75% from 2008 till 2018.

Feasibility of a single mediastinal drain through the abdominal wall after esophagectomy.

This study evaluated the safety and effectiveness of a single mediastinal drainage tube in the thoracic and abdominal cavity after minimally invasive esophagectomy (MIE). This study was undertaken to determine if the procedure could be included in a fast-track surgery program for resectable esophageal carcinoma (EC).From June 17 to November 30, 2015, clinical data for 78 eligible patients who had undergone a fast-track surgery program and MIE were retrospectively analyzed. Twenty-eight patients had a chest tube and mediastinal drainage tube. Thirty-four patients had only a mediastinal drainage tube through the intercostal space. The remaining 30 patients had a single mediastinal drainage tube in the thoracic and abdominal cavity through the abdominal wall. The complication rates and pain scores for each of the groups were compared. The statistical calculations were performed using SPSS 17.0 for Windows (SPSS Inc., Chicago, IL). The quantitative data among the groups were compared using 1-way analysis of variance (ANOVA). The Chi-square, Mann–Whitney U and Fisher exact tests were used for qualitative data analysis.There were no significant differences in the anastomotic leak rates, postoperative days and total complication rates (P = .861). The lowest visual analog scale (VAS) scores of the drainage tubes were observed in the group with a single mediastinal drain through the abdominal wall (P <.001).The results of this study suggested that a single mediastinal drainage tube in the thoracic and abdominal cavity after MIE may be safe and efficient. This clinical practice is a part of our fast-track surgery program.

Application of enhanced recovery after surgery theory based "non-tube, no fasting" in perioperative nursing of esophageal cancer

Objective To explore and evaluate the application effect of enhanced recovery after surgery (ERAS) concept based non-tube, no perioperative nursing method in esophageal cancer. Methods A total of 136 esophageal carcinoma patients who underwent minimally invasive surgery and treated with conventional perioperative care in the thoracic surgery department of the Affiliated Cancer Hospital of Zhengzhou University from March to December 2012 were chosen as the control group. A total number of 132 patients who received minimally invasive surgical treatment from November 2015 to June 2016 were recruited in the observation group, and treated with ERAS concept based non-tube, no perioperative nursing method. All the patients of the two groups were observed for recovery status (including postoperative exhaust and defecation, hospitalization time and ambulation time) and complications (including anastomotic leakage, pulmonary infection and hoarseness) , and the nursing effects were retrospectively analyzed. Results In the observation group, 9 of the 132 patients were unable to implement the nursing measures. Comparing patients' conditions of the observation group with the control group for postoperative exhaust time [ (2.2±0.5) vs. (3.5±1.0) d], postoperative defecation time [ (4.1±1.1) vs. (6.6±0.9) d], ambulation time [ (1.5±0.5) vs. (3.7±1.1) d], and hospitalization time [ (8.2±2.0) vs. (11.0±4.0) d], the differences were statistically significant (P 0.05) . Conclusions For esophageal cancer patients, ERAS concept based perioperative non-tube, no fast track surgery program nursing method can reduce the stress reaction to surgery and treatment, shorten the postoperative hospitalization time and gastrointestinal recovery time without increase of complication incidence. Key words: Esophageal neoplasms; Perioperative nursing; Enhanced recovery after surgery; Non-tube, no fasting

MULTIMODAL STRATEGY FOR THE MANAGEMENT OF SURGICAL PATIENTS(FAST TRACK SURGERY)

There was executed an analysis of the literature data on fast track surgery in foreign and domestic publications for the last 7 years, included in the database PubMed, Medline, Scientific electronic library (elibrary.ru). The review considers in details the principles of fast track surgery and the rationale for their use. The results of application of accelerated rehabilitation programs in surgical specialties are presented and analyzed. The use such programs allow shorten the duration of hospitalization, restore the patient’s ability to work in a more shorter time, without reducing the effectiveness of the treatment, which would have a positive economic effect. The implementation of the fast track surgery program requires a multidisciplinary approach of all specialists involved in perioperative management of the patient.

Midt-Term Results after Fast-Track Prophylactic Carotid Surgery Program: The Risk of Overlooking Occult Cancer

Most guidelines recommend fast-track carotid endarterectomy (CEA) within 14 days of the last ischemic event. Long-term survival after fast-track CEA is unknown. The purpose of this study was to determine whether the fast-track CEA program in our region was associated with a reduced or increased 2-year survival and overall complication rate in our population. Prospective 2-year follow-up in patients after the implementation of a fast-track CEA program during a period of 3½ years. Data on recurrent stroke, myocardial infarction, and death in a 2-year period after CEA were collected along with the indication for surgery and the time from ischemic event to the operation. Two hundred patients underwent CEA. The overall complication rate for 30 days was 3.5% (95% confidence interval [CI], 2%-5%) and 15.5% (95% CI, 13%-18%) for 2 years. During the 2-year follow-up 17 patients (8.5%; 95% CI, 7%-10%) died. Eight patients (4%; 95% CI, 2%-6%) died of advanced cancer (undiagnosed at the index event and CEA time). Of the 6 deaths occurring in patients undergoing CEA 14 days after the index event or earlier, 5 patients (83%; 95% CI, 55%-95%) died of advanced cancer. In the 11 deaths in patients who underwent CEA more than 14 days after the index event, 3 patients (27%; 95% CI, 5%-50%) died of cancer. This was a statistically significant difference (P = .049). Fast-track CEA is a safe procedure in selected patients. Our results show a potential significant risk of overlooking occult cancer, which may affect the long-term benefit from prophylactic CEA.

'Fast-Track' Protocol for Penile Curvature Treatment

Objectives: To describe a multimodal recovery protocol (fast-track surgery) for surgical treatment of penile curvature, as developed by the urology department at the General University Hospital of Valencia over the course of the last 10 years. Our aim was to demonstrate that the use of this protocol improves cost-effectiveness of the procedure, when compared to the classical procedure which requires hospital admission and general or spinal anesthesia.Material and Methods: We compared two groups of patients. The first group underwent strict ambulatory corporoplasty under our multimodal recovery protocol in an out-patient setting, with data collected prospectively. The second group of patients underwent curved penis surgery following the classical procedure before the multimodal recovery protocol was implemented, data was collected retrospectively. We evaluated the inclusion criteria and hospital discharge, as well as obtained results and degree of satisfaction through elaboration of a questionnaire.Results: Results obtained with fast-track protocol were comparable to those of conventional surgery, providing a null incidence of complications except for the inevitable shortening of the penis, clearly independent of the outpatient procedure regimen. The satisfaction degree with the received treatment was found to be over 95%. Conclusions: Virtually all patients affected by penile curvature could are suitable candidates for a fast-track surgery program, with the consequent improvement in cost-effectiveness of the procedure and no reduction of the quality of care received or patient satisfaction.