Table 1 The differences between fast-track and the conventional surgical procedures for colorectal cancer
Parameters | Fast-track surgical procedure | The conventional surgical procedure |
|---|---|---|
Preadmission | Mental optimism. | No mental optimism. |
Counseling | Pre-assessment for risk adjustment. | Pre-assessment for risk adjustment. |
Information for thoracic epidural and general combined anesthesia. | No information for combined anesthesia. | |
Information for fast-track surgical procedure and consent. | Information for the conventional surgical procedure and consent. | |
Surgical preparation | Bowel preparation. | Bowel preparation. |
Enemas. | Enemas. | |
The last meal: 2 h before surgery. | The last meal: 10 h before surgery. | |
Complete enteral nutritional. 500 mL 10% glucose 2–3 h before surgery (if required). | No oral intake on the day of surgery. | |
Gastrointestinal decompression | ~30 min before surgery by the nasogastric tube. | ~30 min before surgery by the nasogastric tube. |
Perioperative management | Thoracic epidural anesthesia. | No thoracic epidural anesthesia. |
Balanced combination with the general anesthesia. | Normal general anesthesia. | |
Mechanical ventilation. | Mechanical ventilation. | |
General anesthesia | Propofol and rocuronium | Propofol and rocuronium |
Opioid | Morphine injection as low as possible. | No restriction of morphine injection use. |
Monitoring | Hemodynamic parameters. | Hemodynamic parameters. |
Prophylaxis | Intravenous antibiotic(s). | Intravenous antibiotic(s). |
Surgery | Laparoscopy/open surgical procedure. | Laparoscopy/open surgical procedure. |
Warming | Yes. | No. |
Drains | Minimal use. | Regular use. |
Fluid infusion | ≤ 1.5 L. | No restriction. |
Pain management | Epidural analgesia + paracetamol infusion. | Sufentanil. |
Postoperative diet | 1-piece chewing gum three times in a day (if required). | Chewing gum. |
200 mL 10% glucose within 1 day after operation (if required). | Fasting until flatus. | |
Liquid diet on the next day of operation (if required). | Liquid diet after flatus. | |
The rehabilitation of diet as early as possible. | Diet after defecation. | |
Intravenous fluid infusion | Maximum for 3 days or until nutritional emulsion administered | High energy fluid on daily basis (infusion) until oral intake. |
Energy | 25–30 kcal/kg/day. | 25–30 kcal/kg/day. |
Nasogastric tube | Removed after surgery. | Removed after the first flatus. |
Urethral catheter | Removed within 2 days after surgery. | Removed when automatic micturition feeling. |
Ambulation | Within 24 h after surgery, ≥ 1 h/day and gradually increased. | No ambulation schemes. |
Adjuvant chemotherapy (if required; institutional protocol) | 8 cycles of capecitabine and oxaliplatin; every 21 days | 12 cycles of leucovorin, fluorouracil, and oxaliplatin; every 15 days |
Hospitalization for chemotherapy | 1 day | 3 days |