Fast-track surgery versus conventional perioperative management of lung cancer-associated pneumonectomy: a randomized controlled clinical trial

Background: The aim of this study is to investigate the effects of fast-track surgery (FTS) on postoperative recovery, hospital stay, total medical costs, and the complications of pneumonectomy in patients with non-small cell lung cancer (NSCLC). Methods: Studies were performed between June 2012 and March 2014 in 17 patients received FTS and 18 patients given conventional management (control) after pneumonectomy in the Department of Thoracic Surgery, the Fourth Affiliated Hospital of Harbin Medical University. Patients were evaluated based on their days to achieve the first postoperative flatus, C-reactive protein (CRP) at postoperative day (POD) 1-7, the length of hospital stay, the medical costs, and postoperative complications. Results: The results showed that in the FTS group, latency to the first postoperative flatus (1.5 +/- 0.6 versus 3.1 +/- 0.8 s in controls, P < 0.0001), CRP (71.36 +/- 5.48 versus 80.71 +/- 8.32 mg/L in at POD 7, P < 0.0001), the length of hospital stay (18.1 +/- 1.4 versus 27.4 +/- 6.6 days, P < 0.0001), and the medical costs (29.9 +/- 2.7 versus 37.2 +/- 3.6 thousand Chinese Yuan, P < 0.0001) were significantly reduced compared to the group receiving conventional management. FTS group also had a relatively lower postoperative complication rate (23.5% of 17 versus 33.3% of 18 in control group) although it was statistically insignificant (P = 0.711). Conclusions: These results indicate that application of the FTS in NSCLC pneumonectomy efficiently accelerates postoperative recovery, shortens hospital stay, reduces the total medical costs of the patients and thus is more acceptable than conventional management.