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
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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
F. Borghi
ASO SANTA CROCE CUNEO
MORTALITA’ A TRENTA GIORNI
2014
F. Borghi
ITALIA
MORTALITA’ A TRENTA GIORNI
F. Borghi
PIEMONTE
MORTALITA’ A TRENTA GIORNI
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
F. Borghi
TM COLON IN LAPAROSCOPIA
DEGENZA POST-OPERATORIA
F. Borghi
PIEMONTE
VOLUME TM COLON
F. Borghi
PIEMONTE
VOLUME TM COLON
F. Borghi
ASO SANTA CROCE CUNEO
VOLUME TM COLON
F. Borghi
PIEMONTE
VOLUME TM COLON LAPAROSCOPICI
F. Borghi
ASO SANTA CROCE CUNEO
VOLUME TM COLON LAPAROSCOPICI
F. Borghi
ITALIA
DEGENZA POST-OP COLON IN LAPAROSCOPIA
F. Borghi
VARIABILITA’ PER REGIONE
DEGENZA POST-OP COLON IN LAPAROSCOPIA
F. Borghi
PIEMONTE
DEGENZA POST-OP COLON IN LAPAROSCOPIA
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
Donohoe CL et al. The surgeon 2011; 9: 95-103F. Borghi
FAST TRACK SURGERY or ERAS:
EVIDENCE
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
FAST TRACK SURGERY or ERAS:
CREATING A MULTIDISCIPLINARY TEAM
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
Fonte: www.agenas.it
From 2010 the
FT protocol was
implemented in
our department
ASO SANTA CROCE CUNEO
DEGENZA POST-OP COLON IN LAPAROSCOPIA
F. Borghi
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