ONCOLOGY LETTERS 18: 651-658, 2019

Rapid rehabilitation nursing in postoperative patients

with colorectal cancer and quality of life
Fang Xu1*, Peipei Yu2* and Li Li3

1
Department of Rheumatic Nephrology; 2Vasculocardiology Department and 3General Department,
The Central Hospital of Wuhan, Tongji Medical College, Huazhong University
of Science and Technology, Wuhan, Hubei 430000, P.R. China

Received September 28, 2018; Accepted May 8, 2019

DOI: 10.3892/ol.2019.10379

Abstract. This study investigated the application of rapid was no significant difference in the 3‑year OS between the two
rehabilitation nursing in postoperative patients with colorectal groups (P>0.05). In conclusion, effectively improving patients'
cancer (CRC) and its effect on quality of life (QOL). A psychological state, reducing complications and relieving
prospective analysis was performed on 154 patients with CRC, pain, the FTS during the perioperative period of CRC surgery
after radical resection in The Central Hospital of Wuhan from promotes postoperative rehabilitation, reduces economic pres-
February 2011 to April 2015. During the perioperative period, sures and improves QOL.
96 patients (study group) received fast‑track surgery (FTS)
and 58 patients (control group) received routine surgery. The Introduction
postoperative data of patients in the two groups were analyzed
in terms of the first anus exhaustion time, the first time getting Colorectal cancer (CRC), the most common malignant tumor
out of bed, first time eating liquid food, first defecation of the digestive tract (1), occurs mostly in countries with low
time, the time of drainage tube removal, time of gastric tube educational level and poor quality of life (QOL), especially
removal, time of suture removal, hospital stay and surgical in people with unhealthy living and dietary habits (2). With
expenses. Visual Analogue Scale (VAS) was used to assess the development of technology and economy, people's pace of
postoperative pain. The re‑hospitalization rate, the incidence life is getting faster, but the QOL gradually declines. In recent
of complications 30 days after operation, the survival and QOL years, the incidence of CRC has increased steadily, accounting
scores were analyzed. After discharge patients were followed for >15% of the systemic malignant tumors (4), and the age of
up for 3 years to observe the 3‑year overall survival (OS). VAS onset has become younger (3), which is mostly 50‑60 years (5).
scores were lower in the study group than that in the control CRC has a high mortality rate, which seriously threatens
group at 6, 12, 24, 48 and 72 h after operation (P<0.05). people's life.
The re‑hospitalization rate and incidence of complications QOL is a medical professional concept comprising social,
30 days after operation were lower in the study group than psychological and material fields (6), which was not valued in
those in the control group (P<0.05). Before nursing, there was the beginning because of limited medical conditions. However,
no statistically significant difference in QOL score between with the development of modern medicine and the changes in
the two groups (P>0.05), whereas after 3 and 12 months of the treatment of tumors, killing tumor cells, reducing tumor
nursing, QOL score was significantly higher in the study diameter and improving tumor differentiation while amelio-
group than that in the control group (P<0.05). QOL score in rating patients' mental state have become crucial (7). Most
the two groups increased with time, and there were differences patients believe that the treatment is unsuccessful if it causes
between the two groups at each time‑point (P<0.05). There severe adverse reactions and even affects QOL (8). QOL mainly
determines the bodily functions (discomfort, fatigue, sleep
quality and sensory function), the psychological state (effects
of negative emotions on themselves, on self‑confidence, and
on learning, memory, thinking and cognitive ability), the inde-
Correspondence to: Dr Li Li, General Department, The Central pendent ability of daily living, social relations, interpersonal
Hospital of Wuhan, Tongji Medical College, Huazhong University of relationships, social returns and the environment (work envi-
Science and Technology, 26 Shengli Road, Wuhan, Hubei 430000, ronment, family environment, property resources and physical
P.R. China
safety) (9).
E‑mail: d3534w@163.com
In recent years, fast‑track surgery (FTS) concept has been
*
Contributed equally strongly promoted in developed countries of Europe and
America (10). It refers to carrying out optimized treatment
Key words: fast‑track surgery, radical resection of colorectal measures on patients during the perioperative period based on
cancer, quality of life, perioperative period medical theory, in order to reduce the surgical stress response
of the body (11). The treatment involves surgeons‑in‑charge,
652 Xu et al: Rapid rehabilitation nursing in colorectal cancer

anesthesiologists, nurses, ICU physicians, dieticians, rehabili- for 6 h before operation, and were orally administered with
tation therapists, psychological counselors, family members, 500 ml of 10% glucose (Chongqing Daxin Pharmaceutical
relatives and friends (12). According to a study, FTS shortens Co., Ltd.; PKU International Healthcare Group; SFDA
hospital stay, reduces postoperative complications and hospital approval no. H50021372) at 2 h before operation, which
cost, and increases inpatient satisfaction (13). effectively reduced postoperative insulin resistance, preop-
With the improvement of surgery and multi‑element erative hunger and psychological pressure. Nutritional Risk
comprehensive treatment, such as radiotherapy and chemo- Screening (NRS) (17) was used for preoperative nutritional
therapy, patients with CRC are mainly treated with laparoscopy assessment. Patients with NRS score ≥3 points were given
combined with radiotherapy and chemotherapy (14). Although nutritional support and were subjected to operation after the
the efficacy is improved and the radical rate is increased, the indicators reached the standard levels, whereas patients with
5‑year survival rate after radical resection remains unsatisfac- NRS score <3 points were subjected to operation.
tory at ~60% (15). Additionally, multi‑element comprehensive
treatment causes adverse reactions, negatively affecting the Intraoperative measures. Short‑acting general anesthetics
patients' daily life, the psychological state and work ability (16). combined with short‑acting regional block anesthetics were
Therefore, identifying ways to improve the postoperative QOL used during the operation. According to some scholars, this
of patients with CRC is imperative. regimen is optimal because it prolongs the analgesic effect of
In this study, the application of FTS concept in patients drugs, reduces the postoperative stress response, and main-
with CRC and its effect on QOL were investigated regarding tains the normal physiological function of patients. Liquid was
the safety and feasibility of FTS in promoting postoperative strictly controlled during the operation, and a heating machine
recovery, in order to provide a reference for clinical practice. was used to maintain patients' normal body temperature, so as
to prevent cardiac overload, water poisoning, cell edema and
Patients and methods other symptoms.

Clinical baseline data. A prospective analysis was performed Postoperative nursing. After operation, patients were given
on 154 patients with CRC after radical resection in The Central non‑steroidal anti‑inflammatory drugs and self‑controlled
Hospital of Wuhan from February 2011 to April 2015. All analgesic mercury for preventing pain, and were intramuscu-
patients underwent colonoscopy before operation, and were larly injected with 40 mg of parecoxib sodium (Pharmacia and
pathologically diagnosed with CRC. According to patients' Upjohn Co.; SFDA approval no. J20080045) for 3 consecutive
wishes and choices, 96 patients receiving FTS during the peri- days, twice daily. Patients carried out activities on the day of
operative period served as the study group, including 36 males operation, got out of bed for 4 h on the 1st day after operation,
and 60 females, with a mean age of 55.38±15.12 years; and were also subjected to microwave treatment for abdominal
58 patients receiving routine surgery served as the control operation. Low‑power red laser (Red and blue light therapy
group, including 24 males and 34 females, with a mean age of apparatus, BH-3L; Beijing Zeao Medical Technology Co., Ltd.)
56.17±15.81 years. was used to irradiate the incision area, which promoted the
healing of the incision tissue, and a paste promoting intestinal
Inclusion and exclusion criteria. Inclusion criteria: patients tract movement was affixed to the navel. Patients drank water
with a first‑listed diagnosis with CRC; patients ≥18 years of age; on the day of operation and ate liquid food on the 1st day after
patients who received regular postoperative follow‑up; patients operation. Antibiotics were injected only on the 1st day after
who were willing to cooperate with the survey and completed operation, and the bladder balloon was removed the next day.
the scale independently. All patients who participated in this
research had complete clinical data. The study was approved Discharge standards. With regular exhaustion, patients could
by the Ethics Committee of The Central Hospital of Wuhan, be discharged if they were fully active and free to eat ordinary
Tongji Medical College, Huazhong University of Science and food, with stable vital signs, good home environment and no
Technology (Wuhan, China). The patients and their family obvious pain.
members were fully informed and signed a consent form.
Exclusion criteria: patients with recurrent CRC; patients Routine surgical concept
with diabetes mellitus; patients with immune diseases; Preoperative preparation. Patients ate liquid food 3 days
patients with cardiac‑cerebral vascular diseases; patients with before operation, fasted 12 h before operation and were also
preoperative intestinal obstruction and hemorrhage. restricted from having water 8 h before surgery. At the same
time, they were orally administered with laxative and subjected
FTS concept to clean enema.
Preoperative preparation. Three days before operation,
psychological intervention was performed on patients, with the Intraoperative measures. A nasogastric tube was inserted
cooperation of family members and friends. The medical staff until the passage of gas by anus, and general anesthetics were
explained nursing knowledge, emergency measures and how used during the operation.
to cooperate with the staff during the perioperative period.
Before operation, the staff established a mutual trust relation- Postoperative nursing. After operation, dolantin (SFDA
ship with patients to improve their compliance, and carried approval no. H63020170), morphine (SFDA approval
out psychological counseling to help patients handle preop- no. H63020013) (both from Qinghai Pharmaceutical Co., Ltd.)
erative pressure and the fear of operation. Patients were fasted and other opioid agents were used for analgesia, and patients
 ONCOLOGY LETTERS 18: 651-658, 2019 653

Table Ⅰ. Baseline data of patients in the study and the control group (n, mean ± SD).

Category Study group (n=96) Control group (n=58) χ2/t P‑value

Sex 0.229 0.733

Male 36 24
Female 60 34
Age (years) 55.38±15.11 56.17±15.81 0.309 0.758
Body mass index (kg/m2) 0.577 0.496
<24 57 38
≥24 39 20
Preoperative Hb (g/l) 124.53±18.64 122.48±20.21 0.641 0.523
Preoperative Alb (g/l) 41.23±3.42 40.53±2.68 1.331 0.185
Preoperative blood glucose (mmol/l) 5.11±1.25 5.21±1.03 0.513 0.609
Preoperative CRP (mg/l) 9.61±3.21 10.22±3.91 1.051 0.295
Tumor location
Left half 12 8 0.053 0.810
Right half 16 11 0.132 0.827
Sigmoid 23 15 0.071 0.848
Rectum 45 24 0.442 0.616
Tumor stage
I 26 14 0.163 0.710
II 41 26 0.066 0.867
III 29 18 0.774 0.451

drank water and ate after exhaustion. Before normal diet, patients were followed up for 3 years to observe the 3‑year
intravenously infused nutrient solution was used as the nutri- overall survival (OS).
tional support, and antibiotics were discontinued after patients'
haemogram and body temperature returned to normal. Determination of QOL. The QOL measurement scale of
patients with cancer, developed by the European Organization
Discharge standards. Patients could be discharged if they for Research on Treatment of Cancer, was used as the judg-
took their own oral diet and were able to walk independently, ment basis (19). QOL before operation, at 3 and 12 months
without intravenous infusion of antibiotics. after nursing was assessed. Functional and symptom scales
were included. Functional scale: physical function (PF), social
Observational indexes function (SF), cognitive function (CF), role function (RF),
General information. Age, sex, body mass index, pathological and emotional function (EF). Symptom scale: constipa-
staging, tumor location and other general baseline data were tion (CO), poverty (PO), insomnia disorder (ID), diarrhea (DI),
recorded. dyspnea (DY), and anorexia (AN). The higher the functional
and symptom scale scores were, the better the QOL was.
Observational indexes of recovery. The postoperative data
of patients in the two groups were analyzed in terms of Interview methods. Surviving patients after discharge were
the first anus exhaustion time, the first time getting out of interviewed by telephone. Patients who were extremely
bed (muscle strength  >4, VAS <3, no discomfort in chief elderly, had poor communication, poor physical quality during
complaint), the first time eating liquid food (control group: the follow‑up period were interviewed through return visit in
after first defection; study group: 1st day after surgery), the patients' houses or consulting with relatives. The follow‑up
first defecation time, time of drainage tube removal (control ended on April 2018, and the OS was calculated as the time
group: drainage <10 ml/day; study group: the 2nd day after from the 1st day after operation to the date of last follow‑up
surgery), time of gastric tube removal (after first intake of or death.
liquid food), time of suture removal (wound healing level
of 1), hospital stay and surgical expenses. Visual Analogue Statistical analysis. In this study, SPSS 17.0 (SPSS, Inc.)
Scale (VAS) (18) was used to assess postoperative pain at 6, software package was used to statistically analyze the data
12, 24, 48 and 72 h after operation. The re‑hospitalization rate and generate the graphs. Enumeration data were expressed as
and incidence of complications (gastrointestinal dysfunction, rate (%) and tested by χ2 test. Measurement data were expressed
intestinal anastomotic fistula, and wound infection) 30 days as mean ± standard deviation (mean ± SD), and tested by t‑test.
after operation, and survival were analyzed. After discharge, Independent samples t‑test was used for comparisons between
654 Xu et al: Rapid rehabilitation nursing in colorectal cancer

Table Ⅱ. Comparison of postoperative basic indicators between the study and the control group (mean ± SD).

Category Study group (n=96) Control group (n=58) t P‑value

First anus exhaustion time (h) 51.12±7.41 73.18±5.83 19.340 <0.001

First leaving‑bed time (h) 37.53±8.52 62.48±9.62 16.770 <0.001
First eating‑liquid food time (h) 14.47±3.53 48.53±6.23 43.330 <0.001
First defecation time (h) 86.45±31.26 112.74±41.24 4.474 <0.001
Time of drainage tube removal (h) 4.56±1.22 7.21±1.73 11.120 <0.001
Time of gastric tube removal (h) 18.32±3.22 97.72±40.17 19.310 <0.001
Time of suture removal (days) 7.12±1.09 8.46±1.98 5.417 <0.001
Postoperative hospital stay (days) 9.46±0.63 11.12±0.52 16.880 <0.001
Operation cost (x104 RMB) 4.73±0.84 5.88±0.73 8.638 <0.001

the study group was 4.56±1.22 h, significantly earlier than

7.21±1.73 h in the control group (t=11.120, P<0.001). The time
of gastric tube removal in the study group was 18.32±3.22 h,
significantly earlier than 97.72±40.17 h in the control group
(t=19.310, P<0.001). The time of suture removal in the study
group was 7.12±1.09 h, significantly earlier than 8.46±1.98 h
in the control group (t=5.417, P<0.001). The hospital stay in the
study group was 9.46±0.63 days, lower than 11.12±0.52 days
in the control group (P<0.001). The surgical expenses in the
study group were 4.73±0.84, lower than 5.88±0.73 in the
control group (P<0.001) (Table II).
Figure 1. VAS score in the study group started to decrease at 12 h after opera-
tion, while in the control group it started to decrease at 24 h after operation.
VAS scores were lower in the study group than those in the control group, at Postoperative pain observation. According to pain assess-
6, 12, 24, 48 and 72 h after operation. * P<0.05, compared to the study group, ment, VAS score in the study group started to decrease at 12 h
indicating a statistically significant difference. VAS, Visual Analogue Scale. after operation, while in the control group started to decrease
at 24 h after operation. At 6 h after operation, VAS score in the
study group was 2.31±0.34, lower than 2.98±0.62 in the control
groups, paired t‑test for comparisons within groups, repeated group (t=8.660, P<0.05). At 12 h after operation, VAS score in
measures analysis of variance for comparisons at multiple the study group was 3.09±0.67, lower than 3.87±0.88 in the
time‑points (denoted by F‑value), Bonferroni post hoc test control group (t=6.207, P<0.05). At 24 h after operation, VAS
for pairwise comparisons, and log‑rank test for Kaplan‑Meier score in the study group was 2.83±0.85, lower than 4.88±0.79
survival analysis. P<0.05 was considered to indicate a statisti- in the control group (t=14.890, P<0.05). At 48 h after opera-
cally significant difference. tion, VAS score in the study group was 1.98±0.74 lower than
2.55±0.72 in the control group (t=4.679, P<0.05). At 72 h after
Results operation, VAS score in the study group was 1.54±0.48, lower
than 2.04±0.61 in the control group (t=5.646, P<0.05) (Fig. 1).
Baseline data. There were no statistically significant differ-
ences between the study and the control group in terms of Re‑hospitalization rate and incidence of complications
age, sex, body mass index, preoperative Hb, preoperative Alb, 30 days after operation. The re‑hospitalization rate 30 days
preoperative blood glucose, preoperative CRP, tumor location after operation in the study group was 3.13%, lower than 13.79%
and tumor staging (P>0.05) (Table I). in the control group ( χ2 =6.204, P=0.021). The incidence
of complications 30 days after operation in the study group
Postoperative basic observation. After the operation, the first was 5.21%, lower than 17.24% in the control group (χ2=5.955,
anus exhaustion time in the study group was 51.12±7.41 h, signif- P= 0.023). There was no statistically significant difference in
icantly earlier than 73.18±5.83 h in the control group (t=19.340, the incidence of separate complications (P>0.05) (Table Ⅲ).
P<0.001). The first time getting out of bed in the study group
was 37.53±8.52 h, significantly earlier than 62.48±9.62 h in the QOL scores at different time‑points. QOL score was compared
control group (t=16.770, P<0.001). The first time eating liquid between the two groups before nursing, at 3 and 12 months after
food in the study group was 14.47±3.53 h, significantly earlier nursing. Before nursing, there was no statistically significant
than 48.53±6.23 h in the control group (t=43.330, P<0.001). difference between the study and the control group (P>0.05),
The first defecation time in the study group was 86.45±31.26 h, whereas after 3 and 12 months of nursing, QOL score was
significantly earlier than 112.74±41.24 h in the control group significantly higher in the study group than that in the control
(t=4.474, P<0.001). The time of drainage tube removal in group (P<0.001). QOL scores in the two groups increased with
 ONCOLOGY LETTERS 18: 651-658, 2019 655

Table III. Comparison of the re‑hospitalization rate and incidence of complications 30 days after operation between the study
and the control group [n (%)].

Category Study group (n=96) Control group (n=58) χ2 P‑value

Re‑hospitalization rate 3 (3.13) 8 (13.79) 6.204 0.021

Incidence of complications 5 (5.21) 10 (17.24) 5.955 0.023
Gastrointestinal dysfunction 1 (1.04) 3 (5.17) 1.079 0.299
Intestinal anastomotic fistula 0 (0.00) 1 (1.72) 0.256 0.798
Wound infection 4 (4.17) 6 (10.34) 1.170 0.242

Table IV. Changes in QOL score at different time‑points (mean ± SD).

QOL score
‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑
Time Study group (n=96) Control group (n=58) t P‑value

Before nursing 65.17±5.26 65.19±6.02 0.025 0.980

3 months after nursing 82.77±6.21 77.78±4.54 5.326 <0.001
12 months after nursing 91.08±6.37 84.55±5.94 6.324 <0.001
F 436.687 171.376
P‑value <0.001 <0.001

QOL, quality of life.

Table Ⅴ. QOL at 3 months after nursing in the study and the control group (mean ± SD).

Category Study group (n=96) Control group (n=58) t P‑value

Functional scale
PF 88.46±2.49 89.26±3.78 1.583 0.116
SF 77.45±2.35 64.57±3.69 26.470 <0.001
CF 93.16±2.36 93.63±1.42 1.373 0.172
RF 82.13±3.24 73.35±4.24 14.470 <0.001
EF 85.74±5.45 68.23±2.93 22.560 <0.001
Symptom scale
CO 8.32±0.77 11.73±1.54 18.270 <0.001
PO 6.54±1.01 10.23±0.69 17.960 <0.001
ID 3.75±0.78 3.26±0.98 1.188 0.237
DI 7.24±1.53 12.37±1.87 18.520 <0.001
DY 4.67±1.35 4.88±1.53 0.889 0.375
AN 1.24±0.42 1.35±0.44 1.547 0.124

QOL, quality of life; PF, physical function; SF, social function; CF, cognitive function; RF, role function; EF, emotional function; CO, constipa-
tion; PO, poverty; ID, insomnia disorder; DI, diarrhea; DY, dyspnea; AN, anorexia.

time, and there were differences between the two groups at SF score in the study group was 77.45±2.35, higher than
each time‑point (P<0.001) (Table Ⅳ). 64.57±3.69 in the control group (t=26.470, P<0.001). RF score
in the study group was 82.13±3.24, higher than 73.35±4.24 in
QOL at 3 months after nursing. At 3 months after nursing, there the control group (t=14.470, P<0.001). Also, EF score in the
were statistically significant differences in SF, RF, EF, CO, study group was 85.74±5.45, higher than 68.23±2.93 in the
PO and DI scores between the two groups (P<0.001), but no control group (t=22.560, P<0.001). In the symptom scale, the
significant differences were observed in other scores (P>0.05). CO score in study group was 8.32±0.77, lower than 11.73±1.54
656 Xu et al: Rapid rehabilitation nursing in colorectal cancer

Table Ⅵ. QOL at 12 months after nursing in the study and the control group (mean ± SD).

Category Study group (n=96) Control group (n=58) t P‑value

Functional scale
PF 97.34±2.04 96.68±2.35 1.836 0.068
SF 95.78±3.46 87.38±2.29 16.430 <0.001
CF 93.96±2.89 93.48±3.73 0.893 0.373
RF 92.43±3.19 84.15±5.28 12.140 <0.001
EF 96.28±2.46 91.21±2.02 12.230 <0.001
Symptom scale
CO 3.45±1.21 3.77±1.02 1.684 0.094
PO 4.89±1.02 5.11±0.59 1.497 0.136
ID 2.33±0.48 2.19±0.46 1.781 0.077
DI 4.65±1.24 4.76±1.39 0.510 0.611
DY 3.42±1.15 3.38±1.22 0.204 0.838
AN 0.87±0.24 0.91±0.26 0.971 0.333

QOL, quality of life; PF, physical function; SF, social function; CF, cognitive function; RF, role function; EF, emotional function; CO, constipa-
tion; PO, poverty; ID, insomnia disorder; DI, diarrhea; DY, dyspnea; AN, anorexia.

groups. The 3‑year OS was 64.58% in the study group and

62.07% in the control group, with no significant difference
between them (χ2=0.552, P=0.458) (Fig. 2).

Discussion

As a common tumor disease with a high incidence and

mortality rate, CRC seriously affects human health (20). It is
treated with surgical resection assisted by radiotherapy and
chemotherapy (21). This treatment improves the local control
rate and overall survival rate and prolongs the life span of
Figure 2. Comparison of the survival rates between the study and the con-
trol group. An interview at 36 months was carried out on patients of the
patients, but it also aggravates toxic and other side‑effects
two groups. The 3‑year OS was 64.58% in the study group, and 62.07% in because of its diversification (16), and also affects QOL for
the control group, with no significant difference between them ( χ2=0.552, a long time. In recent years, QOL is increasingly valued by
P=0.458). OS, overall survival. people. At present, the treatment of cancer has changed from
the improvement of operative effects and survival rate to the
prolongation of survival, improvement of QOL and reduction of
in the control group (t=18.270, P<0.001). PO score in the study psychological burden and adverse reactions (22). Postoperative
group was 6.54±1.01, lower than 10.23±0.69 in the control rehabilitation is influenced by various factors. Routine surgical
group (t=17.960, P<0.001). Also, DI score in the study group concept is limited because it reduces the surgical stress and
was 7.24±1.53, lower than 12.37±1.87 in the control group improves clinical efficacy of patients with CRC only from the
(t=18.520, P<0.001) (Table Ⅴ). perspective of surgery, ignoring mental health and QOL and,
fails to meet the demands for surgical nursing (23).
QOL at 12 months after nursing. At 12 months after nursing, FTS, a new surgical nursing model that has been widely
there were statistically significant differences in SF, RF, used in the nursing of gynecology, orthopedics and general
and EF scores between the two groups (P<0.001), but no surgery (24), refers to nurses, anesthesiologists, patients'
significant differences in any other score (P>0.05). SF score relatives, surgeons, dietitians and rehabilitation therapists
in the study group was 95.78±3.46, higher than 87.38±2.29 in cooperating to minimize stress response during the periopera-
the control group (t=16.430, P<0.001). RF score in the study tive period, promote postoperative rehabilitation, and reduce
group was 92.43±3.19, higher than 84.15±5.28 in the control hospital stay and expenses (25). According to FTS concept,
group (t=12.140, P<0.001). Also, EF score in the study group psychological nursing is feasible during the perioperative
was 96.28±2.46, higher than 91.21±2.02 in the control group period because it promotes clinical treatment. Before operation,
(t=12.230, P<0.001) (Table Ⅵ). most surgical patients suffer from anxiety, fear, nervous-
ness and other psychological disorders, which interfere with
Survival of the study and the control group. An interview at anesthesia and operation, and thereby affect clinical efficacy.
36 months was carried out on patients in the study and control Psychological intervention in patients undergoing laparoscopy
 ONCOLOGY LETTERS 18: 651-658, 2019 657

during the perioperative period eliminates the nervousness and FTS concept during the perioperative period of CRC surgery
fear of operation, reduces psychological burden and improves promotes postoperative rehabilitation, reduces economic
the tolerance to operation and anesthesia (26). pressures and improves QOL. Therefore, the safe, feasible
Compared with routine surgical concept, FTS concept FTS concept with good efficacy is an effective perioperative
is superior during and after operation, which allows for the management model, and is worthy of clinical promotion.
selection of the combination of short‑acting anesthetics and
excludes opioid anesthetics. Opioid anesthetics have a strong Acknowledgements
analgesic effect, but they affect gastrointestinal motility and
intestinal secretion, thereby resulting in slow colonic transit Not applicable.
and inhibition of defecation reflex (27), which is not conducive
to postoperative rehabilitation. According to routine surgical Funding
concept, patients with CRC should be orally administered
with laxative and subjected to clean enema before operation. No funding was received.
However, according to a study, bowel preparation is not benefi-
cial to patients undergoing CRC surgery, which may even Availability of data and materials
increase the incidence of postoperative intestinal anastomotic
leak (28). According to FTS concept, the removal of urethral The datasets used and/or analyzed during the current study are
catheter and drainage tube on the 2nd day after operation available from the corresponding author on reasonable request.
reduces patients' psychological burden and infection rate of
wounds. Preoperative fasting and water deprivation for a long Authors' contributions
time causes thirst, hunger, anxiety, hypoglycemia and hypo-
tension (29). According to FTS concept, 500 ml of 10% oral FX and PY were responsible for the routine surgical concept
glucose taken orally at 2 h before operation effectively reduces nursing. PY drafted the manuscript. FX and LL were respon-
postoperative insulin resistance and preoperative hunger and sible for the analysis of the observation indicators. All authors
psychological pressures. According to Ding et al (30), FTS read and approved the final manuscript.
nursing reduces the incidence of complications, shortens
hospital stay, and improves nursing satisfaction of patients with Ethics approval and consent to participate
CRC. This is similar to our findings. FTS concept is believed
to provide systematic and comprehensive nursing for patients, The study was approved by the Ethics Committee of The
which is conducive to recovery. Central Hospital of Wuhan, Tongji Medical College, Huazhong
In this study, the first anus exhaustion time, the first University of Science and Technology (Wuhan, China). Patients
time getting out of bed, the first time eating liquid food, the who participated in this research had complete clinical data.
first defecation time, time of drainage tube removal, time of Signed informed consents were obtained from the patients or
gastric tube removal, time of suture removal, hospital stay and the guardians.
surgical expenses in the study group were shorter than those
in the control group (P<0.001), indicating that compared with Patient consent for publication
the routine surgical concept, patients with CRC receiving FTS
have more stable vital signs, shorter hospital stay, less surgical Not applicable.
expenses, lower hospital expenses and faster recovery. At
12 h after operation, VAS score was the highest in the study Competing interests
group, and then gradually decreased. Also, VAS scores were
lower in the study group than those in the control group at 6, The authors declare that they have no competing interests.
12, 24, 48 and 72 h after operation (P<0.05), indicating that
FTS concept for the nursing of patients with CRC can reduce References
pain. The re‑hospitalization rate and incidence of complica-
tions 30 days after operation were lower in the study group  1. Ren XL, He GY, Li XM, Men H, Yi LZ, Lu GF, Xin SN, Wu PX,
Li YL, Liao WT, et al: MicroRNA‑206 functions as a tumor
than those in the control group (P<0.05), suggesting that suppressor in colorectal cancer by targeting FMNL2. J Cancer
FTS concept for the nursing of patients with CRC can reduce Res Clin Oncol 142: 581‑592, 2016.
the incidence of postoperative complications, conducive to  2. Leufkens AM, Van Duijnhoven FJ, Boshuizen HC, Siersema PD,
Kunst AE, Mouw T, Tjønneland A, Olsen A, Overvad K,
postoperative recovery. According to QOL evaluation, before Boutron-Ruault MC, et al: Educational level and risk of colorectal
operation there were no significant differences between the cancer in EPIC with specific reference to tumor location. Int J
two groups (P>0.05). The QOL scores in the study group Cancer 130: 622‑630, 2012.
 3. Goldvaser H, Purim O, Kundel Y, Shepshelovich D, Shochat T,
were significantly higher than those in the control group at Shemesh‑Bar L, Sulkes A and Brenner B: Colorectal cancer in
3 and 12 months after nursing (P<0.05), indicating that the young patients: Is it a distinct clinical entity? Int J Clin Oncol 21:
FTS concept can better restore patients' social function and 684‑695, 2016.
 4. Zheng Y and Wu C: Prevalence and trend of gastrointestinal
reduce gastrointestinal dysfunction. FTS concept for the malignant tumors in the elderly over 75 years old in China].
nursing of patients in the long run is beneficial to their behav- Zhonghua Wei Chang Wai Ke Za Zhi 19: 481‑485, 2016
ioral activities. (In Chinese).
 5. Lloyd SC: Methods and systems for improving the prevention
In conclusion, effectively improving patients' psycho- of colorectal cancer. US Patent US 2014/0323802A1. Filed
logical state, reducing complications and improving pain, the March 10, 2014; issued October 30, 2014.
658 Xu et al: Rapid rehabilitation nursing in colorectal cancer

 6. Alam DW and Amin A: Quality of life and well‑being ranking 19. Gamal RM, Mahran SA, Abo El Fetoh N and Janbi F: Quality of
of selected districts of Khyber Pakhtunkhwa, Pakistan. Soc Indic life assessment in Egyptian rheumatoid arthritis patients: Relation
Res 137: 1‑11, 2018. to clinical features and disease activity. Egypt Rheumatol 38:
 7. Frass M, Friehs H, Marosi C, Zedtwitz‑Liebenstein K and 65‑70, 2016.
Zielinski C: Life quality and subjective feeling with additional 20. Ress AL, Perakis S and Pichler M: MicroRNAs and colorectal
homeopathic treatment in cancer patients. Eur J Integr Med 1: cancer: Cancer. In: microRNA: Cancer ‑ From Molecular Biology
223‑224, 2009. to Clinical Practice. Gaetano S (ed). Springer International
 8. Kaseda Y, Ikeda J, Sugihara K and Kohriyama T: The therapeutic Publishing, Switzerland, pp89‑103, 2015.
effects of low‑frequency rTMS on hand function and quality of 21. Ahmed S, Johnson K, Ahmed O and Iqbal N: Advances in the
life in chronic stroke patients relating to functional integrity of management of colorectal cancer: From biology to treatment. Int
the corticospinal tract. J Neurol Sci 381 (Suppl): 600, 2017. J Colorectal Dis 29: 1031‑1042, 2014.
 9. Nowinski CJ, Siderowf A, Simuni T, Wortman C, Moy C and 22. Schrom T, Horenburg L, Holz S and Paschen C: Evaluation of
Cella D: Neuro‑QoL health‑related quality of life measurement quality of life following prosthetic replacement of the auricle.
system: Validation in Parkinson's disease. Mov Disord 31: HNO 58: 134‑141, 2010 (In German).
725‑733, 2016. 23. Cheng Y, Jiang ZS, Xu XP, Zhang Z, Xu TC, Zhou CJ, Qin JS,
10. Temporelli PL and Giannuzzi P: Cardiac rehabilitation after He GL, Gao Y and Pan MX: Laparoendoscopic single-site
cardiac surgery: A valuable opportunity that should not be missed. cholecystectomy vs three-port laparoscopic cholecystectomy:
Eur J Cardiovasc Prev Rehabil 15: 128‑129, 2008. A large-scale retrospective study. World J Gastroenterol 19:
11. Jia W, Liu W and Qiao X: Chinese expert consensus on enhanced 4209‑4213, 2013.
recovery after hepatectomy (version 2017). Asian J Surg 42: 24. Shao Z, Jin G, Ji W, Shen L and Hu X: The role of fast-track
11‑18, 2019. surgery in pancreaticoduodenectomy: A retrospective cohort
12. Robbins CE, Casey D, Bono JV, Murphy SB, Talmo CT and study of 635 consecutive resections. Int J Surg 15: 129‑133, 2015.
Ward DM: A multidisciplinary total hip arthroplasty protocol 25. Zhang LY, Liu ZJ, Shen L and Huang YG: Application of cardio-
with accelerated postoperative rehabilitation: Does the patient pulmonary exercise testing in enhanced recovery after surgery.
benefit? Am J Orthop (Belle Mead NJ) 43: 178‑181, 2014. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 39: 831‑835, 2017
13. Zhang YG, Zhu G, Zhu SC, Liu M, Zhang YQ, Jin B, Wei D, (In Chinese).
Wan B and Wang JY: Comparison of natural orifice transum- 26. Hawasli A, Kandeel A and Meguid A: Single-incision laparo-
bilical endoscopic surgery versus conventional laparoscopic scopic cholecystectomy (SILC): A refined technique. Am J
surgery in renal cyst deroofing. Zhonghua Yi Xue Za Zhi 92: Surg 199: 289‑293; discussion 293, 2010.
276‑278, 2012 (In Chinese). 27. Khansari M, Sohrabi M and Zamani F: The useage of opioids
14. Laudicella M, Walsh B, Munasinghe A and Faiz O: Impact of and their adverse effects in gastrointestinal practice: A review.
laparoscopic versus open surgery on hospital costs for colon Middle East J Dig Dis 5: 5‑16, 2013.
cancer: A population-based retrospective cohort study. BMJ 28. Zhuang Y: Cause analysis and treatment of 17 cases of low rectal
Open 6: e012977, 2016. cancer postoperative anastomotic fistula. Chin Commun Doc 34:
15. Young PE, Womeldorph CM, Johnson EK, Maykel JA, Brucher B, 50‑51, 2014 (In Chinese).
Stojadinovic A, Avital I, Nissan A and Steele SR: Early detection 29. Huang F, Liu SC, Shih SM, Tao YH, Wu JY, Jeng SY and
of colorectal cancer recurrence in patients undergoing surgery Chang P: Reducing the anxiety of surgical patient's families
with curative intent: Current status and challenges. J Cancer 5: access short message service. AMIA Annu Symp Proc 2006:
262‑271, 2014. 957, 2006.
16. Patel S, Lutz JM, Panchagnula U and Bansal S: Anesthesia and 30. Ding SN, Pan HY and Zhang JG: Reevaluation of the method-
perioperative management of colorectal surgical patients ‑ A ological quality in meta-analyses of accelerated rehabilitation on
clinical review (part 1). J Anaesthesiol Clin Pharmacol 28: recovery after surgery for colorectal cancer. Zhonghua Yi Xue
162‑171, 2012. Za Zhi 97: 749‑754, 2017 (In Chinese).
17. Du YP, Li LL, He Q, Li Y, Song H, Lin YJ and Peng JS:
Nutritional risk screening and nutrition assessment for gastroin-
testinal cancer patients. Zhonghua Wei Chang Wai Ke Za Zhi 15: This work is licensed under a Creative Commons
460‑463, 2012 (In Chinese). Attribution-NonCommercial-NoDerivatives 4.0
18. Bao Y, Lyu G, Shao L, Sun X, Cao X, Wang L, Zhu C, Jia J: International (CC BY-NC-ND 4.0) License.
Influence of Jianpi Tiaogan Wenshen Recipe on abdominal pain
Visual Analogue Score (VAS) and defecation of patients with
diarrhea‑predominant irritable bowel syndrome. Chin Arch Trad
Chin Med 3: 650‑652, 2015 (In Chinese).