Accelerated enhanced Recover y following M inimally I nvasive colorectal cancer surgery ( RecoverMI): a study protocol for a novel randomised controlled trial

Brandee A Price, Brian K Bednarski, Y Nancy You, Meryna Manandhar, E Michelle Dean, Zeinab M Alawadi, B Bryce Speer, Vijaya Gottumukkala, Marla Weldon, Robert L Massey, Xuemei Wang, Wei Qiao, George J Chang, Brandee A Price, Brian K Bednarski, Y Nancy You, Meryna Manandhar, E Michelle Dean, Zeinab M Alawadi, B Bryce Speer, Vijaya Gottumukkala, Marla Weldon, Robert L Massey, Xuemei Wang, Wei Qiao, George J Chang

Abstract

Introduction: Definitive treatment of localised colorectal cancer involves surgical resection of the primary tumour. Short-stay colectomies (eg, 23-hours) would have important implications for optimising the efficiency of inpatient care with reduced resource utilisation while improving the overall recovery experience with earlier return to normalcy. It could permit surgical treatment of colorectal cancer in a wider variety of settings, including hospital-based ambulatory surgery environments. While a few studies have shown that discharge within the first 24 hours after minimally invasive colectomy is possible, the safety, feasibility and patient acceptability of a protocol for short-stay colectomy for colorectal cancer have not previously been evaluated in a prospective randomised study. Moreover, given the potential for some patients to experience a delay in recovery of bowel function after colectomy, close outpatient monitoring may be necessary to ensure safe implementation.

Methods and analysis: In order to address this gap, we propose a prospective randomised trial of accelerated enhanced Recovery following Minimally Invasive colorectal cancer surgery (RecoverMI) that leverages the combination of minimally invasive surgery with enhanced recovery protocols and early coordinated outpatient remote televideo conferencing technology (TeleRecovery) to improve postoperative patien-provider communication, enhance postoperative treatment navigation and optimise postdischarge care. We hypothesise that RecoverMI can be safely incorporated into multidisciplinary practice to improve patient outcomes and reduce the overall 30-day duration of hospitalisation while preserving the quality of the patient experience. ETHICS AND DISSEMINATION: RecoverMI has received institutional review board approval and funding from the American Society of Colorectal Surgeons (ASCRS; LPG103). Results from RecoverMI will be published in a peer-reviewed publication and be used to inform a multisite trial.

Trial registration number: NCT02613728; Pre-results.

Keywords: colorectal cancer; colorectal surgery; enhanced recovery after surgery; telemedicine.

Conflict of interest statement

Competing interests: TeleRecovery is facilitated by the exceptional service of our midlevel providers, Kelly R. Maldonado , Brianna L. Whitener, Shanae L Ivey and Erika L Schlette. This study protocol and any subsequent manuscripts will be presented in accordance with the SPIRIT guidelines.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Overall length of stay (LOS) has decreased with the introduction of minimally invasive surgeries (MIS), and many elective procedures (eg, cholecystectomies and appendectomies) are performed on an outpatient basis. Open symbols are MIS (laparoscopy and robotic). Closed symbols are conventional surgeries. Diamonds, hysterectomy; triangles, appendectomy; squares, cholecystectomy; circles, colectomy. Solid lines are trend lines for conventional surgeries. Dashed lines are trend lines for minimally invasive procedures. Orange, colectomy; blue, hysterectomy; green, appendectomy; red, cholecystectomy.
Figure 2
Figure 2
Conceptual model of the RecoverMI trimodality integrated approach to accelerate recovery and improve patient care.
Figure 3
Figure 3
RecoverMI schema. Patients will be enrolled and registered at the preoperative surgical planning visit. Randomisation will occur in the operating room once it is confirmed that the patient will receive minimally invasive surgery without an ostomy. Patients randomised to the intervention arm will be discharged on postoperative day (POD) 1 if their pain is controlled by oral medication and they can tolerate liquids by mouth without nausea. Intervention patients will be monitored by TeleRecovery to reduce postoperative complications, including dehydration and readmission. Quality-of-life (QoL) measurements will be recorded throughout the study.

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