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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (3) : 306-309     DOI: 10.1007/s11684-011-0154-6
“Fast Track” nasogastric decompression of rectal cancer surgery
Ka Li1, Zongguang Zhou1,2(), Zengrong Chen1, Yi Zhang2, Cun Wang1,2
1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; 2. Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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This study evaluates the application of fast track (FT) nasogastric decompression in patients who underwent anterior resection of rectal cancer. A randomized control trial was performed comparing the group with the fast track treatment (n =β57) and the group with traditional nasogastric decompression (n =β84). Preoperative characteristics and postoperative recovery indices were recorded and analyzed. The results indicate no significant differences in gender (P =β0.614), age (P =β0.653), tumor location (P =β0.113), and TNM stages (P =β0.054) were observed between the 2 groups. The differences in the type of resection, anastomosis, and adoption of protective colostomy were all not significant between the FT and the traditional group. During the first 24 hours after surgery, the volume of nasogastric drainage averaged 197 ml in the FT group and 155 ml in the traditional group (P =β0.197). The initiation of test-meal (P =β0.000), semiliquid diet (P =β0.002), and ordinary diet (P =β0.008) were all significantly shorter in the FT group. Furthermore, compared with the other group, the patients in the FT group enjoyed earlier removal of the abdominal drainage, urinary catheter, and shorter hospital stays (P =β0.000). Based on a correlation test, the duration of nasogastric decompression is related to the time of test-meal and semiliquid diet. The routine usage of nasogastric decompression in rectal surgery is unnecessary. The fast track procedure might help in facilitating postoperative functional and diet recovery, reducing the time of catheterization, and shortening hospital stay.

Keywords fast track      nasogastric decompression      rectal cancer      surgery     
Corresponding Authors: Zhou Zongguang,   
Issue Date: 05 September 2011
URL:     OR
FT groupTraditional groupP value
Age (year)56.5±13.756.5±11.90.653
Tumor distance from anus (cm)7.4±8.05.7±3.40.113
TNM stage
Abdominal surgical history
Existing complications
Surgical procedure
Ultra-low anterior resection31440.815
Anterior resection2640
Colo-anal anastomosis
Protective colostomy
Postoperative wards
Surgical ward37430.107
Intensive care unit2041
Tab.1  Clinical and pathological characteristics of included patients
FT groupTraditional groupP value
Nasogastric drainage (ml)a197.6±171.4155.5±142.70.197
Removal of the NGD (day) b1.000±0.0003.1±1.30.000
Time of test meal (day)2.5±1.04.4±2.10.000
Time of semiliquid diet (day)4.1±1.95.8±3.00.002
Time of ordinary diet (day)4.0±0.97.1±4.20.008
Removal of drainage tubes (day)3.3±3.26.5±3.70.000
Removal of urinary catheter (day)4.1±2.26.6±3.50.000
Postoperative hospitalized time (day)9.2±4.612.8±5.60.000
Tab.2  Comparison of recovery indices between the 2 groups
Recovery indicesPearson CorrelationP value
Nasogastric drainage (ml)b0.1050.311
Time of test meal (day)0.5970.000
Time of semiliquid diet (day)0.3900.000
Time of ordinary diet (day)0.3900.066
Removal of drainage tubes (day)0.4250.000
Removal of urinary catheter (day)0.3430.000
Postoperative hospitalized time (day)0.2760.001
Tab.3  Pearson correlation test of recovery indices with the duration of NGD
1 Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005; 92(6): 673-680
doi: 10.1002/bjs.5090 pmid:15912492
2 Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007; (3): CD004929
3 Hasenberg T, L?ngle F, Reibenwein B, Schindler K, Post S, Spies C, Schwenk W, Shang E. Current perioperative practice in rectal surgery in Austria and Germany. Int J Colorectal Dis 2010; 25(7): 855-863
doi: 10.1007/s00384-010-0900-2 pmid:20174809
4 Rao W, Zhang X, Zhang J, Yan R, Hu Z, Wang Q. The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis 2011; 26(4): 423-429
doi: 10.1007/s00384-010-1093-4 pmid:21107848
5 Yang Z, Zheng Q, Wang Z. Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Br J Surg 2008; 95(7): 809-816
doi: 10.1002/bjs.6198 pmid:18551533
6 Kelly MJ, Lloyd TD, Marshall D, Garcea G, Sutton CD, Beach M. A snapshot of MDT working and patient mapping in the UK colorectal cancer centres in 2002. Colorectal Dis 2003; 5(6): 577-581
doi: 10.1046/j.1463-1318.2003.00531.x pmid:14617244
7 Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ 2001; 322(7284): 473-476
doi: 10.1136/bmj.322.7284.473 pmid:11222424
8 Schwenk W, Neudecker J, Raue W, Haase O, Müller JM. “Fast-track” rehabilitation after rectal cancer resection. Int J Colorectal Dis 2006; 21(6): 547-553
doi: 10.1007/s00384-005-0056-7 pmid:16283339
9 Kehlet H. Fast-track colorectal surgery. Lancet 2008; 371(9615): 791-793
doi: 10.1016/S0140-6736(08)60357-8 pmid:18328911
10 Montgomery RC, Bar-Natan MF, Thomas SE, Cheadle WG. Postoperative nasogastric decompression: a prospective randomized trial. South Med J 1996; 89(11): 1063-1066
doi: 10.1097/00007611-199611000-00007 pmid:8903288
11 Wichmann MW, Eben R, Angele MK, Brandenburg F, Goetz AE, Jauch KW. Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study. ANZ J Surg 2007; 77(7): 502-507
doi: 10.1111/j.1445-2197.2007.04138.x pmid:17610680
12 Bauer JJ, Gelernt IM, Salky BA, Kreel I. Is routine postoperative nasogastric decompression really necessary? Ann Surg 1985; 201(2): 233-236
doi: 10.1097/00000658-198502000-00017 pmid:3970606
13 Li C, Mei JW, Yan M, Chen MM, Yao XX, Yang QM, Zhou R, Zhu ZG. Nasogastric decompression for radical gastrectomy for gastric cancer: a prospective randomized controlled study. Dig Surg 2011; 28(3): 167-172
doi: 10.1159/000323744 pmid:21540604
14 Cheatham ML, Chapman WC, Key SP, Sawyers JL. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995; 221(5): 469-476, discussion 476-478
doi: 10.1097/00000658-199505000-00004 pmid:7748028
15 Wolff BG, Pembeton JH, van Heerden JA, Beart RW Jr, Nivatvongs S, Devine RM, Dozois RR, Ilstrup DM. Elective colon and rectal surgery without nasogastric decompression. A prospective, randomized trial. Ann Surg 1989; 209(6): 670-673, discussion 673-675
doi: 10.1097/00000658-198906000-00003 pmid:2658880
16 Otchy DP, Wolff BG, van Heerden JA, Ilstrup DM, Weaver AL, Winter LD. Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia? Results of a prospective, randomized trial. Dis Colon Rectum 1995; 38(6): 604-608
doi: 10.1007/BF02054119 pmid:7774471
17 Lassen K, Hannemann P, Ljungqvist O, Fearon K, Dejong CH, von Meyenfeldt MF, Hausel J, Nygren J, Andersen J, Revhaug A. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ 2005; 330(7505): 1420-1421
doi: 10.1136/bmj.38478.568067.AE pmid:15911535
18 Zhou T, Wu XT, Zhou YJ, Huang X, Fan W, Li YC. Early removing gastrointestinal decompression and early oral feeding improve patients’ rehabilitation after colorectostomy. World J Gastroenterol 2006; 12(15): 2459-2463
19 Roig JV, García-Fadrique A, García Armengol J, Villalba FL, Bruna M, Sancho C, Puche J. Use of nasogastric tubes and drains after colorectal surgery. Have attitudes changed in the last 10 years? Cir Esp 2008; 83(2): 78-84 (in Spanish)
doi: 10.1016/S0009-739X(08)70510-4 pmid:18261413
20 Ng WQ, Neill J. Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review. J Clin Nurs 2006; 15(6): 696-709
doi: 10.1111/j.1365-2702.2006.01389.x pmid:16684165
21 Silk DB, Gow NM. Postoperative starvation after gastrointestinal surgery. Early feeding is beneficial. BMJ 2001; 323(7316): 761-762
doi: 10.1136/bmj.323.7316.761 pmid:11588062
22 Keele AM, Bray MJ, Emery PW, Duncan HD, Silk DB. Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. Gut 1997; 40(3): 393-399
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