Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial

• Published in: Surgical endoscopy Vol. 27; no. 10; pp. 3902 - 3909
• Main Authors: Lee, Sung-Min, Kang, Sung-Bum, Jang, Je-Ho, Park, Jun-Seok, Hong, Samin, Lee, Taek-Gu, Ahn, Soyeon
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.10.2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Analgesics - therapeutic use; Blood Loss, Surgical; Cancer surgery; Carcinoma - rehabilitation; Carcinoma - surgery; Catheters; Cohort analysis; Colorectal cancer; Eating; Female; Fever - epidemiology; Fever - etiology; Gastroenterology; Gynecology; Hepatology; Hospitals; Humans; Ileostomy - methods; Ileostomy - psychology; Ileostomy - rehabilitation; Ileus - epidemiology; Ileus - etiology; Ileus - psychology; Informed consent; Laparoscopy; Laparoscopy - rehabilitation; Laxatives; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Ostomy; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - epidemiology; Pain, Postoperative - psychology; Patients; Postoperative Care - methods; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - psychology; Proctology; Quality of Life; Recovery of Function; Rectal Neoplasms - rehabilitation; Rectal Neoplasms - surgery; Rehabilitation; Risk assessment; Surgery; Urination Disorders - epidemiology; Urination Disorders - etiology; Urination Disorders - psychology; Walking; Young Adult; South Korea; Low anterior resection; Laparoscopic surgery; Rehabilitation programs; Rectal cancer; Randomized controlled trial; Recovery
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-013-3006-4

Background Although early rehabilitation programs have been reported to be effective after laparoscopic colectomy, there is no report of the efficacy of rehabilitation programs after rectal cancer surgery. This study was designed to evaluate the efficacy of an early rehabilitation program after laparoscopic low anterior resection for mid or low rectal cancer in a randomized, controlled trial. Methods Ninety-eight patients who had undergone a laparoscopic low anterior resection with defunctioning ileostomy were randomized on a 1:1 basis to an early rehabilitation program ( n  = 52) or conventional care ( n  = 46). The primary endpoint was recovery rate at 4 days postoperatively. The secondary endpoints were recovery time, postoperative hospital stay, complications, readmission rates, pain on a visual analogue scale, and quality of life (QOL) according to Short Form 36. Results The recovery rates were not different in both groups (rehabilitation, 25 % vs. conventional, 13 %, p  = 0.135). Recovery time and postoperative hospital stay was similar between the groups (rehabilitation, 137 h [107–188] vs. conventional, 146.5 h [115–183], p  = 0.47; 7.5 days [7–11] vs. 8.0 days [7–10], p  = 0.882). The complication rates did not differ between the two groups, but more complications were noted in the rehabilitation program group (42.3 vs. 24.0 %, p   =  0.054), which was related to postoperative ileus (28.8 vs. 13.0 %, p   =  0.057) and acute voiding difficulty (19.6 vs. 4.7 %, p   =  0.032). There was no readmission within 1 month of surgery. Pain and QOL were similar in both groups. Conclusions This randomized trial did not show that an early rehabilitation program is beneficial after laparoscopic low anterior resection. Our results confirm that postoperative ileus and acute voiding difficulty are major obstacles to fast-track surgery for mid or low rectal cancer. This study was registered (registration number NCT00606944).