Background: In retrospective series, mechanical and oral antibiotic bowel preparation (MOABP) has been reported to reduce surgical- site infections (SSIs) after colectomy compared with no bowel preparation (NBP). Method: This was a subgroup analysis of a multicentre randomized trial that included patients scheduled for elective colectomy. The MOABP group underwent mechanical bowel preparation, and took 2 g neomycin and 2 g metronidazole orally during the day before surgery. The NBP group did not undergo bowel preparation. Patients were categorized according to the side of resection (right versus left colectomy), and these subgroups compared for postoperative outcomes. Results: Among 217 patients undergoing right colectomy (106 in MOABP and 111 in NBP group), SSI was detected in seven (7 per cent) and 10 (9 per cent) patients (odds ratio (OR) 0.71, 95 per cent c.i. 0.26 to 1.95; P ¼ 0.510), anastomotic dehiscence in two (2 per cent) and two (2 per cent) patients (OR 1.05, 0.15 to 7.58; P ¼ 1.000), and the mean(s.d.) Comprehensive Complication Index (CCI) score was 9.4(12.9) and 10.5(18.0) (mean difference –1.09; 95 per cent c.i. –5.29 to 3.11; P ¼ 0.608) in the MOABP and NBP groups respectively. Among 164 patients undergoing left colectomy (84 in MOABP and 80 in NBP group), SSI was detected in five (6 per cent) and eight (10 per cent) patients (OR 0.57, 0.18 to 1.82; P ¼ 0.338), anastomotic dehiscence in four (5 per cent) and five (6 per cent) patients (OR 0.75, 0.19 to 2.90; P ¼ 0.742), and the CCI score was 10.2(13.1) and 6.5( 11.0) (mean difference 3.68, –0.06 to 7.42; P ¼ 0.053) in the MOABP and NBP groups respectively. Conclusions: complications in right or left compared with NBP.

The number of colorectal cancer patients increases with age. Long‐term data support personalized management due to heterogeneity within the older population. This registry‐ and population‐based study aimed to analyse long‐term survival, and causes of death, after elective colon cancer surgery in the aged, focusing on patients who survived more than 3 months postoperatively.

Background: To compare the effects of epidural and spinal analgesic regimens on outcomes for patients undergoing laparoscopic ventral rectopexy (LVR) within a fast-track care pathway. Material and methods: This study is a retrospective analysis of prospectively collected data from two time periods. From 2007 to 2009, a total of 38 consecutive patients underwent a standardized LVR within fast-track care pathway and epidural analgesia. The spinal analgesia group consisted of 42 consecutive patients who received similar LVR from 2013 to 2014. Totally intravenous anesthesia regimen and fast-track care pathway were similar during both study periods. The main measures of outcome were postoperative hospital stay, pain scores, and postoperative opioid consumption with 30-day morbidity and readmission rates as secondary outcomes. Results: The study groups were well balanced for baseline characteristics. Postoperative hospital stay was shorter in the spinal than in the epidural group (median 2 versus 3 days, p<0.02). Fifteen of the 42 patients (35.7%) in the spinal group were discharged on postoperative day one versus none in the epidural group. Pain scores were higher in the epidural group on postoperative day one. There were no deaths and only one complication and one conversion to open surgery in the spinal group. Conclusion: Spinal analgesia is a safe analgesic regimen for patients undergoing LVR, and improves mobilization and shortens postoperative stay compared with epidural analgesia in the fast-track setting. Correspondence to: Ilmo Kellokumpu, Department of Surgery, Central Hospital of Central Finland Keskussairaalantie 19, 40620 Jyväskylä, Finland, Fax: +35814-2692929; E-mail: ilmo.kellokumpu@ksshp.fi

Background and Aims: The principle of complete mesocolic excision for colon cancer has been introduced to improve oncologic outcome. However, this approach is scantily discussed for laparoscopic surgery and there is a lack of randomized trials. This study examined oncologic and clinical outcome after laparoscopic wide mesocolic excision and central vascular ligation for colon cancer. Material and Methods: This is a review of prospectively gathered data from a single-institution colorectal cancer database. This study was conducted in the Central Hospital of Central Finland. From January 2003 to December 2011, 222 patients underwent laparoscopic colonic resections with wide mesocolic excision and central vascular ligation in the multimodal setting. The main measures of outcome were cancer recurrence and survival, with early recovery, 30d-mortality and morbidity, reoperation, readmission, and late complications as secondary outcomes. Results: The median follow-up was 5.5 (interquartile range (IQR) = 3.7–8.0) years. The 5-year overall survival for all 222 patients was 80.2% and disease-specific survival was 87.5%, and for those 210 R0-patients with stage I–III disease, 83.9% and 91.3%, respectively. The 5-year disease-free survival was 85.8%: stage I was 94.7%, stage II was 90.8%, and stage III was 75.6% ( p = 0.004). Increasing lymph node ratio significantly decreased the 5-year disease-free survival. Conversion rate to open surgery was 12.2%. Thirty-day mortality was 1.3% and morbidity, 19.7%. Median postoperative hospital stay was 5 (IQR = 3–7) days. Conclusion: Laparoscopic wide mesocolic excision and central vascular ligation for colon cancer resulted in good long-term oncologic outcome. Randomized trials are needed to show that laparoscopic complete mesocolic excision technique would become the standard of care for the carcinoma of the colon.

Background: This study examined short-term clinical outcomes and in-hospital costs of laparoscopic and open colonic resection within fast-track and traditional care pathways.Material and Methods: A case-control study was performed. From 2007 to 2009, 116 patients underwent laparoscopic or open colonic resection for benign or malignant disease within fast-track care pathway. The control group consisted of 116 age-, sex-, comorbidity-, type of surgery-, and diagnosis-matched patients who received a traditional perioperative care from 2000 to 2007. The main measures of outcome were postoperative hospital stay and in-hospital costs, with 30-day mortality, morbidity, reoperation, and readmission rates as secondary outcomes.Results: The study groups were well balanced for baseline characteristics. Postoperative hospital stay was shorter in the fast-track than in the control group: laparoscopic resection median 3 versus 5days (p<0.001) and open resection 4 versus 7days (p<0.001). In multivariate analysis fast-track care, laparoscopic surgery and complications were independent determinants affecting the length of hospital stay. Overall, there was a trend toward lower in-hospital costs in the fast-track group compared with the traditional care group, but the difference was not statistically significant. Open surgery within fast-track care was the least costly option compared to laparoscopic or open surgery within traditional care but not significantly so when compared with laparoscopy within fast-track care. Intake of solid food and bowel function recovered 1day earlier in the fast-track group than in the control group (p<0.001). Complications were more frequent after open surgery than after laparoscopic surgery (23.3% vs 11.0%, p=0.012). Reoperation and readmission rates were similar between the study groups.Conclusion: Laparoscopy improves the efficiency of fast-track perioperative care without significantly increasing in-hospital costs.

Background and Aims: Fast-track protocols have been used to optimize the perioperative care and to enhance postoperative recovery. This study examined short-term clinical outcomes and determinants affecting the length of postoperative hospital stay. Material and Methods: From 2007 to 2009, 180 patients underwent laparoscopic or open bowel resection ( N = 138) or sacrocolporectopexy ( N = 42) in the Central Hospital of Central Finland for various colorectal diseases in the fast-track setting. The main measures of outcome were time to functional recovery, 30-day morbidity, and readmission rates, with hospital stay and patient satisfaction as secondary outcomes. Results: There were no deaths. Time to functional recovery was median 2 (interquartile range 2–3) days. The overall 30-day postoperative morbidity was 14.5% after bowel resection and 0% after sacrocolporectopexy. Relaparotomy rate was 3.6% and 30-day readmission rate 7.2%. Postoperative hospital stay was median 3 days after small bowel and ileo-colic resection, 4 days after segmental colectomy, and 6 days after rectal resection and subtotal colectomy. Patient’s body mass index > 30 kg/m2, malignant disease, complexity of surgery, recovery of bowel function later than 2 days after surgery, time to functional recovery > 2 days and postoperative morbidity were patient- and treatment-related determinants increasing postoperative hospital stay. Protocol compliance–related determinants increasing postoperative hospital stay were intake of normal food and mobilization ≥ 6 h/day later than 2 days after surgery and removal of urinary catheter later than 1 day after surgery. Conclusion: Postoperative functional recovery was fast, morbidity and readmission rates were low, and postoperative hospital stay short indicating that fast-track care should form the mainstay of elective colorectal surgery.