TY - JOUR
T1 - Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study)
AU - Vlug, Malaika S.
AU - Wind, Jan
AU - Hollmann, Markus W.
AU - Ubbink, Dirk T.
AU - Cense, Huib A.
AU - Engel, Alexander F.
AU - Gerhards, Michael F.
AU - van Wagensveld, Bart A.
AU - van der Zaag, Edwin S.
AU - van Geloven, Anna A. W.
AU - Sprangers, Mirjam A. G.
AU - Cuesta, Miguel A.
AU - Bemelman, Willem A.
AU - AUTHOR GROUP
AU - Preckel, Benedikt
AU - Bossuyt, Patrick
AU - Gouma, Dirk
AU - van Berge Henegouwen, Mark
AU - Fuhring, Jan
AU - van Lenthe, Ineke Picard
AU - Bakker, Chris
AU - King-Kalimanis, Bellinda
AU - Hofland, Jan
AU - Dejong, Cornelis
AU - van Dam, Ronald
AU - van der Peet, Donald
AU - van Zalingen, Edith
AU - Noordhuis, Astrid
AU - de Jong, Dick
AU - Goei, T. Hauwy
AU - de Stoppelaar, Erica
AU - van den Dongen, Marjon
AU - van Tets, Willem
AU - van den Elsen, Maarten
AU - Swart, Annemiek
AU - deWit, Laurens
AU - Siepel, Muriel
AU - Molly, Glaresa
AU - Juttmann, Jan
AU - Clevers, Wilfred
AU - Bieleman, Andrea
AU - Coenen, Ludo
AU - Bonekamp, Elly
AU - van Abeelen, Jacobus
AU - van Iterson-de Jong, Diana
AU - Krombeen, Margriet
AU - Engel, AF
PY - 2011
Y1 - 2011
N2 - To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. Important developments in elective colorectal surgery are the introduction of laparoscopy and implementation of FT care, both focusing on faster recovery. In a 9-center trial, patients eligible for segmental colectomy were randomized to laparoscopic or open colectomy, and to FT or standard care, resulting in 4 treatment groups. Primary outcome was total postoperative hospital stay (THS). Secondary outcomes were postoperative hospital stay (PHS), morbidity, reoperation rate, readmission rate, in-hospital mortality, quality of life at 2 and 4 weeks, patient satisfaction and in-hospital costs. Four hundred patients were required to find a minimum difference of 1 day in hospital stay. Median THS in the laparoscopic/FT group was 5 (interquar-tile range: 4-8) days; open/FT 7 (5-11) days; laparoscopic/standard 6 (4.5-9.5) days, and open/standard 7 (6-13) days (P < 0.001). Median PHS in the laparoscopic/FT group was 5 (4-7) days; open/FT 6 (4.5-10) days; laparoscopic/standard 6 (4-8.5) days and open/standard 7 (6-10.5) days (P < 0.001). Secondary outcomes did not differ significantly among the groups. Regression analysis showed that laparoscopy was the only independent predictive factor to reduce hospital stay and morbidity. Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program. If open surgery is applied, it is preferentially done in FT care. This study was registered under NTR222 (www.trialregister.nl)
AB - To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. Important developments in elective colorectal surgery are the introduction of laparoscopy and implementation of FT care, both focusing on faster recovery. In a 9-center trial, patients eligible for segmental colectomy were randomized to laparoscopic or open colectomy, and to FT or standard care, resulting in 4 treatment groups. Primary outcome was total postoperative hospital stay (THS). Secondary outcomes were postoperative hospital stay (PHS), morbidity, reoperation rate, readmission rate, in-hospital mortality, quality of life at 2 and 4 weeks, patient satisfaction and in-hospital costs. Four hundred patients were required to find a minimum difference of 1 day in hospital stay. Median THS in the laparoscopic/FT group was 5 (interquar-tile range: 4-8) days; open/FT 7 (5-11) days; laparoscopic/standard 6 (4.5-9.5) days, and open/standard 7 (6-13) days (P < 0.001). Median PHS in the laparoscopic/FT group was 5 (4-7) days; open/FT 6 (4.5-10) days; laparoscopic/standard 6 (4-8.5) days and open/standard 7 (6-10.5) days (P < 0.001). Secondary outcomes did not differ significantly among the groups. Regression analysis showed that laparoscopy was the only independent predictive factor to reduce hospital stay and morbidity. Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program. If open surgery is applied, it is preferentially done in FT care. This study was registered under NTR222 (www.trialregister.nl)
U2 - https://doi.org/10.1097/SLA.0b013e31821fd1ce
DO - https://doi.org/10.1097/SLA.0b013e31821fd1ce
M3 - Article
C2 - 21597360
SN - 0003-4932
VL - 254
SP - 868
EP - 875
JO - Annals of Surgery
JF - Annals of Surgery
IS - 6
ER -