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Abstract：
BACKGROUND: Although enhanced recovery programs (ERPs) have been proven to be beneficial after laparoscopic colon surgery, they may result in adverse clinical outcomes following failure. This study analyzed risk factors associated with ERP failure after laparoscopic colon cancer surgery.
METHODS: We analyzed the outcomes of 208 patients who underwent ERPs following laparoscopic colon cancer surgery between June 2007 and April 2013. The ERP included early oral feeding, early ambulation, and regular laxative administration. ERP failure was defined as postoperative hospital stay of more than 5 days related to postoperative complications, unplanned readmission within 30 days of surgery, or death.
RESULTS: Surgical procedures included anterior resection (n = 101), right hemicolectomy (n = 90), and left hemicolectomy (n = 17). The mean postoperative hospital stay was 6.5 ± 2.3 days (range 3-24 days). ERP failure occurred in 36 patients (17.3%), with no mortality; reasons included ileus (n = 14), wound infection (n = 4), chylous drainage (n = 3), anastomotic bleeding (n = 3), pneumonia (n = 1), or readmission (n = 11) owing to delayed complications. Univariable analysis showed that ERP failure was associated with proximal colon cancer, side-to-side anastomosis, longer operation time, increased blood loss, and longer resected specimen length. Multivariable analysis showed that side-to-side anastomosis [odds ratio (OR) 4.534; 95% confidence interval (CI) 1.902-10.811; P = 0.001] and increased blood loss (OR 1.004; 95% CI 1.001-1.008; P = 0.041) were independent risk factors for ERP failure.
CONCLUSIONS: We showed that increased blood loss and side-to-side anastomosis in comparison with end-to-end anastomosis were independent risk factors associated with ERP failure after laparoscopic colon cancer surgery. This suggests that intraoperative elements may be important determinants to obtain successful postoperative recovery in the era of ERP.
METHODS: We analyzed the outcomes of 208 patients who underwent ERPs following laparoscopic colon cancer surgery between June 2007 and April 2013. The ERP included early oral feeding, early ambulation, and regular laxative administration. ERP failure was defined as postoperative hospital stay of more than 5 days related to postoperative complications, unplanned readmission within 30 days of surgery, or death.
RESULTS: Surgical procedures included anterior resection (n = 101), right hemicolectomy (n = 90), and left hemicolectomy (n = 17). The mean postoperative hospital stay was 6.5 ± 2.3 days (range 3-24 days). ERP failure occurred in 36 patients (17.3%), with no mortality; reasons included ileus (n = 14), wound infection (n = 4), chylous drainage (n = 3), anastomotic bleeding (n = 3), pneumonia (n = 1), or readmission (n = 11) owing to delayed complications. Univariable analysis showed that ERP failure was associated with proximal colon cancer, side-to-side anastomosis, longer operation time, increased blood loss, and longer resected specimen length. Multivariable analysis showed that side-to-side anastomosis [odds ratio (OR) 4.534; 95% confidence interval (CI) 1.902-10.811; P = 0.001] and increased blood loss (OR 1.004; 95% CI 1.001-1.008; P = 0.041) were independent risk factors for ERP failure.
CONCLUSIONS: We showed that increased blood loss and side-to-side anastomosis in comparison with end-to-end anastomosis were independent risk factors associated with ERP failure after laparoscopic colon cancer surgery. This suggests that intraoperative elements may be important determinants to obtain successful postoperative recovery in the era of ERP.
摘要：
背景：尽管已证明增强恢复计划（ERPs）在腹腔镜结肠手术后是有益的，失败后可能导致不良临床结局.本研究分析了腹腔镜结肠癌术后ERP失败的危险因素。
方法：我们分析了2007年6月至2013年4月在腹腔镜结肠癌手术后接受ERPs的208例患者的结果。ERP包括早期口服喂养，早期行走，和定期的泻药管理。ERP失败定义为术后住院时间超过5天，与术后并发症有关。手术后30天内计划外再入院,或死亡。
结果：外科手术包括前切除术（n=101），右半结肠切除术（n=90），左半结肠切除术（n=17）。术后平均住院时间为6.5±2.3天（范围3-24天）。36例（17.3%）发生ERP失败，无死亡；原因包括肠梗阻(n=14)，伤口感染（n=4），乳糜引流（n=3），吻合口出血（n=3），肺炎（n=1），或因延迟并发症而再次入院（n=11）。单变量分析显示ERP失败与近端结肠癌相关,侧侧吻合,更长的操作时间，失血量增加,切除标本长度较长。多因素分析显示，侧侧吻合[比值比（OR）4.534；95％置信区间（CI）1.902-10.811；P=0.001]和失血量增加（OR1.004；95％CI1.001-1.008；P=0.041）是ERP失败的独立危险因素。
结论：我们发现，与端对端吻合相比，失血量增加和侧对侧吻合是腹腔镜结肠癌术后ERP失败的独立危险因素。这表明术中要素可能是在ERP时代获得成功的术后恢复的重要决定因素。
方法：我们分析了2007年6月至2013年4月在腹腔镜结肠癌手术后接受ERPs的208例患者的结果。ERP包括早期口服喂养，早期行走，和定期的泻药管理。ERP失败定义为术后住院时间超过5天，与术后并发症有关。手术后30天内计划外再入院,或死亡。
结果：外科手术包括前切除术（n=101），右半结肠切除术（n=90），左半结肠切除术（n=17）。术后平均住院时间为6.5±2.3天（范围3-24天）。36例（17.3%）发生ERP失败，无死亡；原因包括肠梗阻(n=14)，伤口感染（n=4），乳糜引流（n=3），吻合口出血（n=3），肺炎（n=1），或因延迟并发症而再次入院（n=11）。单变量分析显示ERP失败与近端结肠癌相关,侧侧吻合,更长的操作时间，失血量增加,切除标本长度较长。多因素分析显示，侧侧吻合[比值比（OR）4.534；95％置信区间（CI）1.902-10.811；P=0.001]和失血量增加（OR1.004；95％CI1.001-1.008；P=0.041）是ERP失败的独立危险因素。
结论：我们发现，与端对端吻合相比，失血量增加和侧对侧吻合是腹腔镜结肠癌术后ERP失败的独立危险因素。这表明术中要素可能是在ERP时代获得成功的术后恢复的重要决定因素。
