TUMORI MALIGNI del COLON:
MORTALITA’ A 30 GIORNI
e DEGENZA POST-OPERATORIA
Dott. Felice Borghi
Struttura Complessa di Chirurgia Generale
A.S.O. S. Croce e Carle - Cuneo
F. Borghi
MORTALITA’ A TRENTA GIORNI
CARTELLE CLINICHE
8 decessi a 30gg
6 IC urgenti
2 IC elettivi
1 colon dx
1 colon sx
Deiscenza
anastomotica
Kehlet H. Br J Anaesth 1997;78:606–17.
“Fast track surgery" (or ERAS) is a concept, first described by
Kehlet in 1990's that employs a multimodal peri-operative care
pathway with the aim of attenuating the stress response and
accelerating recovery.
F. Borghi
FAST TRACK SURGERY or ERAS:
DEFINITION
Gustaffson et al. World J Surg 2013 DOI 10.1007/s00268-012-1772-0
F. Borghi
FAST TRACK SURGERY or ERAS:
ITEMS
Author Year Pts RCT (FT vs no FT) Pts CCT (FT vs no FT)
Wind 2006 3 (64 vs 64) 3 (191 vs 195)
Gouvas 2009 4 (99 vs 101) 7 (447 vs 416)
Eskicioglu 2009 4 (198) /
Walter 2009 2 (33 vs 31) 2 (153 vs 159)
Varadhan 2010 6 (226 vs 226) /
Spanjersberg 2011 4 (119 vs 118) /
Adamina 2011 6 (226 vs 226) /
Lv 2012 7 (419 vs 433) /
Lemanu 2013 (costs) 2 5
Zhuang 2013 13 (1910) /
Greco 2013 16 (1181 vs 1195) /
Shao 2014 13 (9+4*) (1962) /
Li 2014 6 (323 vs 332) /
Zhao 2014 5 (696 vs 621) 5
Wang 2014 24 (2093 vs 1272) /
Spanjerberg 2015 3 (520 pts) 5 (422 pts)
Implementation of FT program in colorectal surgery:
reduction in LOS, post operative morbidity and cost.
F. Borghi
FAST TRACK SURGERY or ERAS:
META-ANALYSIS
ERAS pathway significantly reduced overall morbidity (15.1 % in the ERAS
group vs 24.6 % in the control group)
Greco M et al. World J Surg 2013 DOI 10.1007/s00268-013-2416-8
F. Borghi
FAST TRACK SURGERY or ERAS:
OVERALL COMPLICATIONS
A significant reduction in nonsurgical complications was found in the ERAS
group (3.0 %) versus the control group (7.5 %)
Greco M et al. World J Surg 2013 DOI 10.1007/s00268-013-2416-8
F. Borghi
FAST TRACK SURGERY or ERAS:
NON SURGICAL COMPLICATIONS
Greco M et al. World J Surg 2013 DOI 10.1007/s00268-013-2416-8
F. Borghi
FAST TRACK SURGERY or ERAS:
POST-OPERATIVE STAY
In metanalysis mean LOS is 5.8 days in the ERAS group and 8.0 days in the
control group (p<0.001).
H. Kehlet and DW. Wilmore. Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery.
Ann Surg 2008; 248: 189-198.
FAST TRACK SURGERY or ERAS:
HOW TO IMPLEMENT IT?
F. Borghi
St. Luc’s University Hospital Brussels – Belgium
Department of Abdominal Surgery and Transplantation
Colorectal Surgery Unit (Prof. Alex Kartheuser)
ASO S. Croce e Carle Cuneo - Italy
Dipartimento chirurgico
SC Chirurgia Generale (Direttore: Dr. F. Borghi)
FAST TRACK SURGERY or ERAS:
VISITING CENTER WITH EXPERIENCE
F. Borghi
656 pazienti
Patients (M:F) 383/273
Age (mean) 68,6 [25-91 anni]
BMI (Kg/m^2) 25.3 ± 4.7 Kg/m2
Benign disease (%)47 (7,5%)
Cancer or polyp (%)607 (92,5%)
FAST TRACK SURGERY or ERAS:
PERSONAL EXPERIENCE (2010 – 03/2016)
F. Borghi
656 patients
Median post operative stay (days)4 days [range, 2-35]
Major complications (Dindo-Clavien 1-2)216 (32,9%)
Major complications (Dindo-Clavien 3-4)35 (5,3%)
Mortality (Dindo-Clavien 5) (30 days)1 (0,1%)
Re-admissions (30 days) (%)17 (2,6%)
Re-intervention after discharge1 (0,1%)
PERSONAL EXPERIENCE IN FT:
POSTOPERATIVE DATA
F. Borghi
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