New Study on Fast Track Inpatient Rehabilitation in Liver Cancer

Barry Kraynack, MD

Multimodal rehabilitation, also known as “fast track” or “enhanced recovery”, has been shown to hasten recovery, decrease medical complications and reduce the time that patients spend in the hospital for cancer surgery.

Liver resection is a high risk, major surgery that has a median hospital stay in Denmark of 9 days for liver resection and 15 days after right hemi-hepatectomy . In a new study that was just released in the British Journal of Surgery, Schultz and colleagues investigated the effect of introducing fast track principles for patients undergoing open or laparoscopic liver resection. [1]They removed catheters and drains early, mobilized patients and began feeding patients immediately after surgery. Pain control (analgesia) was optimized and provided for the first week after surgery.

In this study, the researchers found that the introduction of this multimodal fast track rehabilitation care accelerated postoperative recovery, achieving a shorter hospital stay of 2 days for laparoscopic resection to 6 days following open surgery. There was no observed mortality and readmission rate was acceptably low. The authors concluded, “Open liver resections, even right and left hemi-hepatectomies, can be carried out safely and provide shorter hospital says. Fast-track liver surgery is safe, and has a low readmission rate.” Their results are similar to those reported by others for different types of cancer. With cost containment a major concern for medicine, it’s important to consider implementing fast track cancer rehabilitation care.

[1]Schultz NA, Larsen PN, Klarskov B, Plum LM, Frederiksen HJ, Kehlet H, Hillings JG. Evaluation of a fast-track programme for patients undergoing liver resection. Br J Surg. 2013; 100(1):138-43.


Research Demonstrates that Multidisciplinary Cancer Rehabilitation is Effective

Julie Silver, MD

A recent systematic review of twenty-two studies on cancer rehabilitation that was published in the prestigious medical journal The Oncologist demonstrated that multidisciplinary cancer rehabilitation is effective.[1] In this review that evaluated the current research and was titled “Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General”, there were 16 effectiveness and 6 cost-effectiveness studies—22 studies in all–that were included. The individual studies were performed in many different countries, including the United States and Canada. The researchers noted that despite the fact that the individual studies assessed different rehabilitation interventions, they demonstrated statistically significant benefits for multidimensional rehabilitation over usual care. This is an important new evidence-based review of the current research that supports multidisciplinary cancer rehabilitation.

[1]Mewes JC, Steuten LM, Ijzerman MJ, van Harten WH. Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General: A Systematic Review. The oncologist. 2012. Epub 2012/09/18. doi: 10.1634/theoncologist.2012-0151. PubMed PMID: 22982580.