“Fast Track” nasogastric decompression of rectal cancer surgery

Abstract

This study evaluates the application of fast track (FT) nasogastric decompression in patients who underwent anterior resection of rectal cancer. A randomized control trial was performed comparing the group with the fast track treatment (n =β57) and the group with traditional nasogastric decompression (n =β84). Preoperative characteristics and postoperative recovery indices were recorded and analyzed. The results indicate no significant differences in gender (P =β0.614), age (P =β0.653), tumor location (P =β0.113), and TNM stages (P =β0.054) were observed between the 2 groups. The differences in the type of resection, anastomosis, and adoption of protective colostomy were all not significant between the FT and the traditional group. During the first 24 hours after surgery, the volume of nasogastric drainage averaged 197 ml in the FT group and 155 ml in the traditional group (P =β0.197). The initiation of test-meal (P =β0.000), semiliquid diet (P =β0.002), and ordinary diet (P =β0.008) were all significantly shorter in the FT group. Furthermore, compared with the other group, the patients in the FT group enjoyed earlier removal of the abdominal drainage, urinary catheter, and shorter hospital stays (P =β0.000). Based on a correlation test, the duration of nasogastric decompression is related to the time of test-meal and semiliquid diet. The routine usage of nasogastric decompression in rectal surgery is unnecessary. The fast track procedure might help in facilitating postoperative functional and diet recovery, reducing the time of catheterization, and shortening hospital stay.

Keywords

fast track / nasogastric decompression / rectal cancer / surgery

References

[1] Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005; 92(6): 673-680

[2] Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007; (3): CD004929

[3] Hasenberg T, Längle F, Reibenwein B, Schindler K, Post S, Spies C, Schwenk W, Shang E. Current perioperative practice in rectal surgery in Austria and Germany. Int J Colorectal Dis 2010; 25(7): 855-863

[4] Rao W, Zhang X, Zhang J, Yan R, Hu Z, Wang Q. The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis 2011; 26(4): 423-429

[5] Yang Z, Zheng Q, Wang Z. Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Br J Surg 2008; 95(7): 809-816

[6] Kelly MJ, Lloyd TD, Marshall D, Garcea G, Sutton CD, Beach M. A snapshot of MDT working and patient mapping in the UK colorectal cancer centres in 2002. Colorectal Dis 2003; 5(6): 577-581

[7] Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ 2001; 322(7284): 473-476

[8] Schwenk W, Neudecker J, Raue W, Haase O, Müller JM. “Fast-track” rehabilitation after rectal cancer resection. Int J Colorectal Dis 2006; 21(6): 547-553

[9] Kehlet H. Fast-track colorectal surgery. Lancet 2008; 371(9615): 791-793

[10] Montgomery RC, Bar-Natan MF, Thomas SE, Cheadle WG. Postoperative nasogastric decompression: a prospective randomized trial. South Med J 1996; 89(11): 1063-1066

[11] Wichmann MW, Eben R, Angele MK, Brandenburg F, Goetz AE, Jauch KW. Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study. ANZ J Surg 2007; 77(7): 502-507

[12] Bauer JJ, Gelernt IM, Salky BA, Kreel I. Is routine postoperative nasogastric decompression really necessary? Ann Surg 1985; 201(2): 233-236

[13] Li C, Mei JW, Yan M, Chen MM, Yao XX, Yang QM, Zhou R, Zhu ZG. Nasogastric decompression for radical gastrectomy for gastric cancer: a prospective randomized controlled study. Dig Surg 2011; 28(3): 167-172

[14] Cheatham ML, Chapman WC, Key SP, Sawyers JL. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995; 221(5): 469-476, discussion 476-478

[15] Wolff BG, Pembeton JH, van Heerden JA, Beart RW Jr, Nivatvongs S, Devine RM, Dozois RR, Ilstrup DM. Elective colon and rectal surgery without nasogastric decompression. A prospective, randomized trial. Ann Surg 1989; 209(6): 670-673, discussion 673-675

[16] Otchy DP, Wolff BG, van Heerden JA, Ilstrup DM, Weaver AL, Winter LD. Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia? Results of a prospective, randomized trial. Dis Colon Rectum 1995; 38(6): 604-608

[17] Lassen K, Hannemann P, Ljungqvist O, Fearon K, Dejong CH, von Meyenfeldt MF, Hausel J, Nygren J, Andersen J, Revhaug A. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ 2005; 330(7505): 1420-1421

[18] Zhou T, Wu XT, Zhou YJ, Huang X, Fan W, Li YC. Early removing gastrointestinal decompression and early oral feeding improve patients’ rehabilitation after colorectostomy. World J Gastroenterol 2006; 12(15): 2459-2463

[19] Roig JV, García-Fadrique A, García Armengol J, Villalba FL, Bruna M, Sancho C, Puche J. Use of nasogastric tubes and drains after colorectal surgery. Have attitudes changed in the last 10 years? Cir Esp 2008; 83(2): 78-84 (in Spanish)

[20] Ng WQ, Neill J. Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review. J Clin Nurs 2006; 15(6): 696-709

[21] Silk DB, Gow NM. Postoperative starvation after gastrointestinal surgery. Early feeding is beneficial. BMJ 2001; 323(7316): 761-762

[22] Keele AM, Bray MJ, Emery PW, Duncan HD, Silk DB. Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. Gut 1997; 40(3): 393-399

Acknowledgements

This work was supported by the Foundation for the Author of National Excellent Doctoral Dissertation of China (Grant No. FANEDD 2007B66) and by the National Science Foundation of China (Grant No. 30801331).

RIGHTS & PERMISSIONS

2014 Higher Education Press and Springer-Verlag Berlin Heidelberg