TUMORI MALIGNI del COLON - Rete Oncologica Piemonte · TUMORI MALIGNI del COLON: MORTALITA’ A 30...

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


F. Borghi

PIEMONTE


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CARTELLE CLINICHE

8 decessi a 30gg

6 IC urgenti

2 IC elettivi

1 colon dx

1 colon sx

Deiscenza

anastomotica

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TM COLON IN LAPAROSCOPIA

DEGENZA POST-OPERATORIA

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PIEMONTE

VOLUME TM COLON

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VOLUME TM COLON

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PIEMONTE

VOLUME TM COLON LAPAROSCOPICI

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VOLUME TM COLON LAPAROSCOPICI

F. Borghi

ITALIA

DEGENZA POST-OP COLON IN LAPAROSCOPIA

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VARIABILITA’ PER REGIONE


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PIEMONTE


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.

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FAST TRACK SURGERY or ERAS:

DEFINITION

Gustaffson et al. World J Surg 2013 DOI 10.1007/s00268-012-1772-0

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ITEMS

Donohoe CL et al. The surgeon 2011; 9: 95-103F. Borghi


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.

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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

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OVERALL COMPLICATIONS

A significant reduction in nonsurgical complications was found in the ERAS

group (3.0 %) versus the control group (7.5 %)


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NON SURGICAL COMPLICATIONS


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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.


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)


VISITING CENTER WITH EXPERIENCE

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CREATING A MULTIDISCIPLINARY TEAM

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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%)


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



F. Borghi

TUMORI MALIGNI del COLON - Rete Oncologica Piemonte · TUMORI MALIGNI del COLON: MORTALITA’ A 30...

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