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Fast-track Colorectal Surgery in China—3 years’ Experience
1. Fast-
Fast-track Colorectal Surgery
in China—3 years’ Experience
China— y p
Anal colorectal Surgery
Analcolorectal Surgery
West China Hospital of Sichuan University, China
Li Li Ph.D. M.D. Wang Xiaodong M.D.
Li Li Ph D M D Wang Xiaodong M D
2. The Seed of FT Conception
Following the foreign papers in 2001~2005
2007
Two important reviews published
The FastTrack Programmes of MultiDisciplinary Treatment in Colorectal Surgery.
Th F t T k P f M lti Di i li T t ti C l t lS
Chin J Bases Clin General Surg , 2007, 14(2): 239242 (Liu Z, Wang XD, Li L)
FOCUS ON Clinical Management Strategy
Cli i l M t St t
Nutrition and Fast Track Surgery.
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Parenteral & Enteral Nutrition, 2007, 14(2): 6567 (Li JS)
FOCUS ON Postoperation Rehabilitation in Nutrition
3. The Spread of FT Conception
Published papers in 2007~2009
the centers with FT studies ongoing
(Papers)
20
15 11
10 4
1
5 7 7
4
0
(Year)
2007 2008 2009
Review Original Article
4. The Characteristics in Current Studies
53% published papers in Secondary literature
The papers from retrospect studies mainly
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Small samples in studies
Similar studies based on some foreign papers
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The studies for colon surgery more than rectal surgery
Adopt rules reported in foreign papers
Less studies for links in FT management
Less studies for links in FT management
Lack the details in particular target from FT clinic
5. The Rethink from Chinese Experiences
West China Hospital of Sichuan University
West China Hospital of Sichuan University
The biggest hospital in China
More than 800 cases colorectal operations per year
More than 800 cases colorectal operations per year
Started FT management since 2005
More than 1,000 cases following FT management
Evidence based Medical Center of China
Evidence based Medical Center of China
MDT work group in Anal‐colorectal Surgery
6. Building up FT Guideline
Single center
Evidence level in III IV
Evidence level in III~IV grades
Fast Track Guideline for Colorectal Surgery of
West China Hospital in Sichuan University
Published in 2009
Chin J Bases Clin General Surg, 16, (58)
7. FT Guideline in Single Center
Points in Preoperation
Introduction FT management to patients
Selection:
•Admission
•Operative preparation
Simplifying Intestinal Preparation
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Selection:
•By oral intestinal cleaner 12h preop.
•Drink water or tea till 6h preop.
•Intestinal Obstruction included in FT
8. Points in Introoperation
Anaesthesia
Selection:
•Recommend continuous epidural anesthesia
•Enough dose in first injection if chosen general anesthesia
Operation
S l i
Selection:
•Best choice in mini‐incision laparotomy
•Recommend laparoscopic resection
Si lif i d t d d d i ti
•Simplifying and standard procedure in operation
•Short time and less bleeding
9. Points in Postoperation
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Nursing and Education
Rehabilitation strategy
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Selection:
•Fluid restriction: decreasing total volume to 500ml in 3 days
•Nasogastric tube: without or keeping in 1 day
•Drainage tube: without or keeping in 1 day
•Urinary catheter: keeping in 1~3 days
E l ti iti 24h t
•Early activities: 24h postop.
•Early oral feeding: water or tea 24h postop. and common diet 48h postop.
•Regular pain‐control
•Strengthen anti infection
•Strengthen anti‐infection
•Anti‐inflammatory response by hormone
•Treatment in accelerating intestinal motility by drugs
•Protection the quality in sleeping
•Protection the quality in sleeping
10. Restrict rules in discharge
Normal in vital sign
No feature in incision infection and abdominal signs
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Tolerance general diet
Basic activities in wards
Acceptable anal exsufflation or defecation
Independent urination
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OUTCOMES HIGHLIGHTS
Until to OCT 2009: Discoveries:
•Operative related re admission 0 8%
•Operative related re‐admission 0.8% •Cured pts. with severe complications successfully
•Total morbidity post‐op. 17.2%
•Operative related mortality <0.5% •Cured pts. with intestinal obstruction successfully
11. Advanced FT researches
Series Prospective researches
Single center to multi centers
Single center to multi‐centers
Fast track programme
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in Colorectal Cancer Surgery
Supported by
2009 Science Research Projects in Health Department of Sichuan (NO. 090353)
FT related RCTs are registering
12. The difficulties of FT in China
Culture
Accept observation for long time in hospital
Require “no complications” in clinic
Economy
Fee afforded by insurance based on in‐hospital days
Clinic
Cli i
Incomplete healthy services in communities
Collaboration in multi‐disciplinary influence progression
13. The Future of FT in China
Cooperation with centers from Europe
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Construction of Chinese FT network
Reform in details of FT with Chinese conditions
14. Welcome to China !
Welcome to hometown of Panda—Sichuan !
Contact to:
Dr. Wang Xiaodong
lockwan@163.com
86-28-138-8226-7388
http://www.recentcrs.com