Conventional group | Modified group | |
---|---|---|
Perioperative | ||
Counseling | Pulmonary rehabilitation | Pathway explanation and informative booklet |
Intraoperative | ||
Analgesia | Not standardized | Multimodal: TAP block for laparoscopic surgery + CNS-targeted drugs |
Prophylaxis | Antibiotic prophylaxis, VTE (pharmacological and mechanical) | Antibiotic prophylaxis, VTE (pharmacological and mechanical) |
Fluids | Not standardized | Goal-directed fluid management |
Extubation | Immediate extubation | Immediate extubation |
NGT | Remove on POD 1 | Remove at the end of surgery |
Postoperative | ||
Analgesia | Not standardized | NSAIDs |
Fluid | Not standardized | Zero balance goal; stop iv fluid within POD 4 |
Abdominal drain | Always placed | Always placed. No routine anastomotic leak test. Removed on POD 5 |
Line management | Not standardized | Remove urinary catheter on POD 2 |
Diet | POD 2 clear fluids, POD 4 soft diet | POD 1 clear fluids, POD 2,3 nutritional supplement, POD 4 soft diet |
Rehabilitation | Not standardized | POD 1–3 pulmonary physiotherapy POD 1 chair and bedside exercise POD 2–3 assisted ambulation |
Herbal medicine | None | Dai-kenchu-to (15 g/day) |