Clinical analysis of open and laparoscopy-assisted surgery for colorectal cancer

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  • 当科における開腹下と腹腔鏡補助下大腸癌手術症例の比較検討
  • トウ カ ニ オケル カイフク カ ト フククウキョウ ホジョ カ ダイチョウガン シュジュツ ショウレイ ノ ヒカク ケントウ

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Abstract

<p>Background: We have introduced a clinical pathway (CP) to improve the quality of medical care, following an analysis of the variances between the CPs for open and laparoscopy-assisted surgery for colorectal cancer, mainly with regard to perioperative care.</p><p>Subject and Methods: The subjects of our analysis were the 244 colorectal cancer cases that came through our hospital between February 2006, when the hospital introduced electronic medical records, and November 2011, excluding 27 cases that dropped off the clinical pathway. We analyzed the timing of first post-operative ambulation, flatus, and defecation, as well as the timing of discharge and permission for discharge.</p><p>Results: The completion rate for the CPs was 88.9% (217 of 244 cases). The first postoperative ambulation was significantly earlier for laparoscopy-assisted colectomy (1.69 days) than for open colectomy (2.24 days) (p=0.03). The first post-operative flatus following laparoscopy-assisted low anterior resection (1.81 days) was significantly earlier than that following open low anterior resection (2.22 days)(p=0.025). The average timing among all cases for first post-operative ambulation and flatus was 2 days, and was 4 days for defecation. There was no greatly remarkable difference between open and laparoscopy-assisted surgery in terms of the timing of discharge and permission for discharge; the overall average length until patients were able to be discharged was about 13 days for open surgery and about 12 days for laparoscopy-assisted surgery.</p><p>Conclusion: The early recovery of ambulation and bowel activity suggests that the first post-operative oral intake might be moved forward in cases of laparoscopy-assisted surgery. The length of hospitalization, moreover, could be shortened in the laparoscopy group following further analysis of the timing of permission for discharge. As a result of having introduced variance analysis, we were able to clear up certain issues in traditional perioperative management, leading to a safer and more efficient perioperative course for the patient.</p>

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